UCF Celebrates First "Doctor of Physical Therapy" Graduates in the Nation

[medicinesux]

Watch out PM&R Docs! Looks like you just got some more competition. Why in the hel! do physical therapists need a "doctorate" may I ask? This dishing out doctorates like candy has gone completely out of control now.

"UCF Celebrates First Doctor of Physical Therapy Graduates"


http://today.ucf.edu/ucf-celebrates-...erapy-program/

ADDENDUM:
Scratch out "In the Nation" in the title to this thread. Just got schooled on how this has been going on now for ten years.

"There remains significant criticism[2] regarding the granting of a doctoral level degree for a field that until 1998 only required a bachelors degree.[3] The concern centers around both the need for such a degree and the possibility that physical therapists may incur substantial student debt with an extended education that pays no greater than it did when only a bachelors degree was required."

Nevertheless, you PM&R guys need to stick together and get ready for a coming assault on your turf.

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[PMR 4 MSK]

Watch out PM&R Docs! Looks like you just got some more competition. Why in the hel! do physical therapists need a "doctorate" may I ask? This dishing out doctorates like candy has gone completely out of control now.

"UCF Celebrates First Doctor of Physical Therapy Graduates"


http://today.ucf.edu/ucf-celebrates-...erapy-program/

ADDENDUM:
Scratch out "In the Nation" in the title to this thread. Just got schooled on how this has been going on now for ten years.

"There remains significant criticism[2] regarding the granting of a doctoral level degree for a field that until 1998 only required a bachelors degree.[3] The concern centers around both the need for such a degree and the possibility that physical therapists may incur substantial student debt with an extended education that pays no greater than it did when only a bachelors degree was required."

Nevertheless, you PM&R guys need to stick together and get ready for a coming assault on your turf.

I'm not really worried. They first have to get direct-patient access, which requires law changes. They'll get it in some states, maybe most or all eventually.

Then they have to establish themselves as the go-to guys for MSK injuries and pain. That'll take a lot of marketing.

Then they have to convince insurance companies to pay them without a physician referral - that'll be harder.

Most DPTs will likely be willing to work with docs to get referrals they would miss out on otherwise. There will be some competition, but we will both have a good place in MSK care.

 

[ColinHay]

A doctorate is an academic degree that anyone who studies enough can earn.
(Otherwise you might ask why do sociology professors need a doctorate?)
This does not make them physicians.

 

[Bombesin]

Colin I agree with you except in one instance: DNP's. I have no problem referring to dentists, veterinarians, PhD's, etc, as "doctor" because they function in different theaters than medical doctors. Nurse practitioners function in the same theater as medical doctors. But according to a recent article, DNP's are beginning to introduce themselves as "Doctor So-and-So" at the point of care. I don't know how true or widespread that it is, but I am wholly against it. In the medical world, there is only one doctor. It confuses the patient and quite frankly, I think it insults the hard work we all did to get to this point. That said, let me be clear that I have nothing against NP's and I recognize their contribution to healthcare, but they are not doctors. If they want the title and the same practice rights, then they should have gone to medical school, or at the very least, pass the MD/DO licensing exams. I think the push for doctorates in everything, whether needed or not, is the notion that a higher level of education = higher salary.

Then they have to establish themselves as the go-to guys for MSK injuries and pain. That'll take a lot of marketing.

Don't they already have greater market exposure than PM&R docs? People associate physical therapy with muscle and injury. And they know what PT's do. They hear "physical medicine and rehabilitation" and think, "oh, physical therapist!" Marketing might already be a lost battle, no?

 

[RUOkie]

There have been DPTs for >10 years. This article only demonstrates that UCF had their first class graduate. The APTA has mandated that all new PT's have DPTs in lieu of MS-PT

 

[ASUAZCOM]

I think the push for doctorates in everything, whether needed or not, is the notion that a higher level of education = higher salary.

And schools are motivated to offer these degrees because they can charge higher tuition rates.

 

[Bombesin]

And schools are motivated to offer these degrees because they can charge higher tuition rates.

Bingo

 

[TUCOMSam]

I think there are bigger and badder "turf wars" out there (eg CRNA's vs anesthesiologists) CRNAs in the salary realm, make more $ than most primary care docs (and probably PM&R for that matter).

Regarding DPT's, let 'em get their extra 2 semesters of school and introduce themselves as Dr. Therapist... When they begin hitting roadblocks associated with ordering studies/labs and interpreting these when they have no training as such, let the liability be on them also.

Then again, not so sure the big scary DPT's are really trying to gain this turf anyway. Think they'd rather focus on PNF, Bobath, etc. Maybe I'm naive.

 

[eljefe]

I think there are bigger and badder "turf wars" out there (eg CRNA's vs anesthesiologists) CRNAs in the salary realm, make more $ than most primary care docs (and probably PM&R for that matter).

Regarding DPT's, let 'em get their extra 2 semesters of school and introduce themselves as Dr. Therapist... When they begin hitting roadblocks associated with ordering studies/labs and interpreting these when they have no training as such, let the liability be on them also.

Then again, not so sure the big scary DPT's are really trying to gain this turf anyway. Think they'd rather focus on PNF, Bobath, etc. Maybe I'm naive.

1. Most PM&R docs don't care about CRNAs other than a scope of practice litmus test. DPTs have the potential to adversely affect us, not CRNAs (except possibly pain).
2. Check some salary info on CRNAs vs. PM&R before you post
3. DPTs like money like everyone else and they will see a lot more of it if they can push through direct access. You're naive.

 

[Socrates25]

You guys are foolish to ignore this threat. There was a time when NPs and CRNAs also had significant "obstacles" to their declared intentions of practicing medicine without a license. Alas, slowly but surely these obstacles have been put aside by clever marketing and legal loopholes.

The DPTs are sure to follow suit. They're not stupid, they're going to go where the money is, and the money is in what the PM&R docs do. They will pursue script privileges, direct access, pain management, the works. They will call themselves "doctor" and try to obfuscate the training differences between the two professions.

Might not happen today, might not happen 5 years from now, but it WILL happen. Mark it down. There is not a single midlevel field that has not pushed for autonomy/independence at some point. They want what you got, and they're prepared to fight dirty to get it.

Ignore it at your own peril.

 

[TUCOMSam]

1. Most PM&R docs don't care about CRNAs other than a scope of practice litmus test. DPTs have the potential to adversely affect us, not CRNAs (except possibly pain).
2. Check some salary info on CRNAs vs. PM&R before you post
3. DPTs like money like everyone else and they will see a lot more of it if they can push through direct access. You're naive.

The statement re: CRNA is exactly a litmus test. Interpret it however you would like. The fact remains it is a current and greater turf war in the realm of medicine vs nursing. The truth is they do on average make more than many MDs (eg primary care and many physiatrists) even though they are midlevels. SO... I have done my homework "before I post."

"According to a Merritt Hawkins & Associates study from 2009 the average salary for CRNAs was $189,000. Although in 2005 the average annual CRNA salary was reported as $160,000..."

RE: direct access for PT? You're right, many probably do follow the money just like many physicians. However, allowing for direct access is not how they will do it. As it is, 16 states already allow unlimited direct access, with the remaining states having direct access "with provisions" except OK & HI which are evaluation only. An example of this: The mean salary for PT in Oklahoma City is $68,000 (a state without any form of direct access except for evaluation). In Omaha, NE (a state with similar demographics and cost of living with unlimited direct access since 1957), the mean salary is $70,500. It would seem that simply allowing direct access is not the means to making bank. So am I naive or just not prematurely jaded? Perhaps you should "check some salary info" before you post.

 

[eljefe]

I think there are bigger and badder "turf wars" out there (eg CRNA's vs anesthesiologists) CRNAs in the salary realm, make more $ than most primary care docs (and probably PM&R for that matter).

Regarding DPT's, let 'em get their extra 2 semesters of school and introduce themselves as Dr. Therapist... When they begin hitting roadblocks associated with ordering studies/labs and interpreting these when they have no training as such, let the liability be on them also.

Then again, not so sure the big scary DPT's are really trying to gain this turf anyway. Think they'd rather focus on PNF, Bobath, etc. Maybe I'm naive.

I do not intend on starting a pissing match--

Your original statement implied that CRNAs make more than PM&R. This is not true (although there are always outliers), even with your Merritt Hawkins data. The industry standard salary data for non-academic positions is the MGMA. 2008 MGMA data has PM&R with a mean of $261K, 25th percential of $199K, Median $234K, 75th $290K and 90th $379K. Therefore, the "check some salary info before you post" comment.

In regard to direct access--we'll have to agree to disagree. I am not a DPT etc., but there is a clear push to expand their scope of practice, which starts with direct referral.

 

[rcheeley]

I am a DPT, and I would like to respectfully disagree w/ many of your comments.

At medicinesux: Yes, the DPT has been around for about 10 years now, and no one seemed to care about this until the profession started it's direct access push. I'm curious as to why you think there will be a turf war. What is it we as PTs are trying to do that encrouches on what PM&R physicians do?

At PMR 4 MSK: You say that we, as PTs, need to establish ourselves in regards to the musculoskeletal system. I believe there was a study done in recent years where physicians in different areas of practice, and PTs were all tested on their musculoskeletal knowledge base and the PTs scored 2nd highest behind the orthopedic surgeons. I do believe PTs, along w/ Orthos and PM&R are the musculoskeletal experts, as well as DCs when speaking about the spine.

I think Colin summarizes the general purpose of the DPT, and it's just the expanded level of education in the PT programs that is being taught. I don't look at it as the PT profession trying to crossover into the physicians roles, it's just the profession becoming, as a whole, better practitioners.

Common complaints are "why do PTs need to know how to read radiographs, understand medications, etc." It's so that we know how to best treat this patient in regards to their condition, as well as understand common side-effects associated w/ medications and how they may affect that patients treatment. It is NOT to be able to one day order imaging studies, or prescribe medications, but to understand them better.

At ASUAZCOM and others: I do not believe the primary motivation for offering the DPT program is to be able to increase tuition. All tuition rates across the country are increasing, and those associated w/ PT programs have not increased anymore due to the change to DPT programs (no more than any other program).

At TUCOMSam and others: Just FYI, most DPTs DO NOT introduce themselves as "Dr. so and so." They introduce themselves as "Dr. <insert last name>"...just kidding. No, in all seriousness, we are actually taught in PT school that it is unethical for our profession to go by Dr. X, and the only time a PT should go by Dr. is if they have a Ph.D or some other degree that would warrant them to be called doctor. So the PTs that do go by Dr., do so after they have been instructed otherwise by their school. Again, I do not believe our profession actually wants to order imaging studies, we learn about this in order to be able to better interpret them in regards to patient care. I think many PT student misunderstand this and think they should be able to order them.

At Socrates25: I think your post regarding the DPT is very aggressive to say the least. There are significant differences between the PM&R physician and PT. In a best case scenario, these two professions should work very closer together to treat the patient in the best way possible. Unfortunately, this is not always the case. I often have a VERY difficult time speaking w/ or contacting physicians and often times must speak w/ the RN, who in most cases, does not have a clue what I am talking about in regards to this patient. To say that money is the primary reason for the push is very insulting.

At TUCOMSam: Great post about direct access. Many states already allow this and 1 or 2 have done so for a very long time. We as PTs do not want direct access to "get a piece of the pie" per say, but to have faster access to patients w/ musculoskeletal issues that we can easily treat while in the acute and subacute stages vs the later chronic stages. There are many studies out there showing how much better outcomes are (specifically LBP) when the patient was seen by a PT within 2 weeks of initial injury vs being seen 4, 6 and 12 weeks following injury.

At eljefe: Again, the push for direct access is not about expanding our scope of practice. Our practice will never change from the treatment of neuomusculoskeletal issues in regards to function. If this were the case, I would say you have all the right in the world to disagree, but it isn't. It's all about patient care, and doing what is best for the patient. If that includes faster access to PT services, then it should be allowed without them having to see 1, 2, and sometimes 3 different physicians before being seen by a PT.

I definately understand where most of you are coming from w/ your concerns/complaints. However I believe many of them are based on assumptions and "rumors" that are not entirely true. I do believe there are many PTs out there that want to use their level of education to their advantage and falsely represent themselves to patients. Yes, we are Doctors of Physical Therapy, however this only indicates a level of education and does not indicate the desire to proclaim ourselves as Physicians, MDs, DOs, etc. Our desire to learn and gain a greater knowledge base, especially in the areas of pharmacology, imaging, differential diagnosis (mechanical vs pathological), etc is not so that we can some day consider ourselves equal w/ the physician, it is so that we can be better prepared to treat these patients that are becoming more and more complex all the time.

I believe it is wrong to talk in a negative manner about a profession, especially one that is trying to better itself. To say this is wrong is like telling a professional athlete that he is too good and he needs to play at the level of the rest of the athletes.

 

[Booyamc]

You have way too much time on your hand

Definately the start of enchroachment, like other specialties are seeing. I would avoid referring to a DPT to make a point.

 

[atstudent]

At PMR 4 MSK: You say that we, as PTs, need to establish ourselves in regards to the musculoskeletal system. I believe there was a study done in recent years where physicians in different areas of practice, and PTs were all tested on their musculoskeletal knowledge base and the PTs scored 2nd highest behind the orthopedic surgeons. I do believe PTs, along w/ athletic trainers, Orthos and PM&R are the musculoskeletal experts, as well as DCs when speaking about the spine.

At eljefe: Again, the push for direct access is not about expanding our scope of practice. Our practice will never change from the treatment of neuomusculoskeletal issues in regards to function. If this were the case, I would say you have all the right in the world to disagree, but it isn't. It's all about patient care, and doing what is best for the patient. If that includes faster access to PT services, then it should be allowed without them having to see 1, 2, and sometimes 3 different physicians before being seen by a PT.

So if it's all about the patient, I'm sure you would have no problem if Athletic Trainers be reimbursed for our services, right? I mean.. it's not about the money; but the PATIENT, right?

 

[MotionDoc]

So if it's all about the patient, I'm sure you would have no problem if Athletic Trainers be reimbursed for our services, right? I mean.. it's not about the money; but the PATIENT, right?

Yea, actually it is about the patient. Do you feel it should be otherwise?

 

[rcheeley]

That is a question I could not answer as I do not understand or have the knowledge base for several aspects of this question - athletic trainers course of study, scope of practice, insurance reimbursement practices, etc.

Sorry but I won't debate or try and answer something I know nothing about.

But yes, I will agree w/ MotionDoc... it is, and should always be, all about the patient.

Once again, I understand money and insurance companies rule the world, but I believe I mentioned money/income/insurance maybe 1 or 2 times in my entire post. However, it seems to be the first and only issue brought up. Why?

 

[Booyamc]

Obviously it's about the pt so provide them with the most highly trained professional (PMR)

But please don't be naive and think people don't have a right to earn a living and protect their profession

Link to study?

 

[atstudent]

Yea, actually it is about the patient. Do you feel it should be otherwise?

No, I'm all about the patient. First and foremost. But the APTA and from what I've read a large chunk of its members believe that an athletic trainer is unable to help a patient. They are wrong. So they want a larger "piece of the pie" but at the same time they balk at another profession trying to get "a piece of the pie."

 

[MotionDoc]

A degree represents a certain level of education in a specific field. The DPT requires a higher level of education when compared against the MPT, thus the name change. Criticism abounds that this was simply the addition of an extra year of imaging, pharmacology, and diff diagnosis courses, but the reality is that this change in education is different in both quantity (years) and quality (philosophy), but in no way is it meant to infringe on the practice of medical doctors.

In addition to the added didactic education, the very nature and context of previous PT training was transformed from the training of a rehabilitation tech that essentially followed a physician-prescribed protocol for an already evaluated patient, to the training of an autonomous thinking PT...aka, a practitioner that can see a patient off the street, evaluate his/her condition, then ultimately decide if the patient is a candidate for physical therapy (is there suspicion of an underlying pathology?) and if not, who is the right practitioner to refer to (physician/dentist/psychiatrist/etc...).

A medical doctor is not confused with an attorney with a juris doctorate, a neurobiologist with a PhD, nor a physical therapist who has a doctorate in PT. Each have attained the highest level of education in their respective fields, and are capable of autonomous practice...their degrees reflect this.

In action, here is a silly little example: Mrs. Jones walks in with a chief complaint of "side pain" that starts near the center of her mid-to-low back. This pain follows a certain dermatome pattern causing the PT to think: radiculopathy. However, oddly enough, her pain can't be made worse with movement, position, or any form of mechanical manipulation, and on inspection, the area appears red and warm. After further probing, Mrs. Jones offers that the pain "just started out of no where." So, with a suspicious history and multiple red flags during the evaluation, the PT refers Mrs. Jones to her physician along with these findings. Subsequently, a "herpes zoster radiculopathy" diagnosis is made.

An integration of medical knowledge that is relevant to physical therapy practice is now the norm from day one of PT school. The goal is not to diagnose (and treat) pathology, rather recognizing non-mechanical signs that warrant referral to a physician. In fact, as many of you already know, the pathology model fails miserably to direct rehabilitation in many areas of PT management (LBP most notably), and many PTs just "give it up" all together and follow outcome based clinical predication rules and rehabilitation protocols.

A physician is a physician is a physician. An autonomous physical therapist is a physical therapist is a physical therapist. We may work with the same joints, nerves, bones, and muscles, but we do not do the same things. We both want to see patients better, and the PT profession is collectively pushing onward with the goal of providing better care. Healthcare is a team effort; we are trying to make the team better.

 

[bridge47]

Wow, this article really shows me how little you guys really know about what PT does, and little respect.
I'm a student PT and yeah I think it's dumb that I will develop ridiculous debt ($150,000 is average for my program) to work in a field that won't pay that off in reasonable time. But do I still think the move to DPT is right? Yes, because I believe it has more to do with advancing our field so someday reimbursement will be higher and we will have real direct access. I live in Georgia where we can evaluate a patient without a doctor's script, but cannot treat them until they have it. And even if we could, insurance wouldn't cover it without the script.
I finished my outpatient ortho rotation and I realize why direct access is needed, it would save time and money. I received many scripts from doctors simply stating "low back pain" or "R shoulder pain". Did they really need to see an MD to figure that out? Maybe to give them the heavy pain meds they don't like taking bcause it knocks them out or hurts their stomach. So many patients states how pleased they were with how thorough we were with our evaluations, unlike the docs who would spend less than 5 minutes with them (almost always primary care who of course are no experts in the musculoskeletal arena). Why waste the patient's time and copay with that?
So no, PTs are not trying to take over your field, and yes maybe we would like to get paid something worthy of this debt we are taking on.
Regarding imaging, I can't read it and don't want to, but there are so many times we had to continue to see if PT was "working or not" before an MRI would be done based on the insurance and/or MD. I would rather like to be able to know right off what it really is as no special test is perfect.

I respect MDs a lot, you have a hard job. But please respect us too, even if I don't ask you to call me Dr.

 

[MotionDoc]

No, I'm all about the patient. First and foremost. But the APTA and from what I've read a large chunk of its members believe that an athletic trainer is unable to help a patient. They are wrong. So they want a larger "piece of the pie" but at the same time they balk at another profession trying to get "a piece of the pie."

A number of PTs are also ATCs, and from where I am from, most will agree that ATCs provide the standard level of care for athletes. From what I remember, most sports programs won't even let a PT work with athletes unless they are also ATCs (and many sports med physicians also are ATCs)...

 

[PMR 4 MSK]

At PMR 4 MSK: You say that we, as PTs, need to establish ourselves in regards to the musculoskeletal system. I believe there was a study done in recent years where physicians in different areas of practice, and PTs were all tested on their musculoskeletal knowledge base and the PTs scored 2nd highest behind the orthopedic surgeons. I do believe PTs, along w/ Orthos and PM&R are the musculoskeletal experts, as well as DCs when speaking about the spine.

I believe you misinterpret what I said. I feel PT's will need to establish themselves (in the public eye) as the go-to guys for MSK problems, not that they have a knowledge deficit in this area. They will simply have to market themselves successfully enough to change people's perception of where to go when you hurt your back, pull a muscle, etc. Right now, when they get an acute MSK injury, most people decide to go to their PCP, an ortho or a chiro. PT's will need to market well enough to break that thought line.

It's the same problem we Physiatrists face in dealing with referrals. PCPs in general are so ingrained in the thought of "MSK = ortho" so every problem we can manage goes to ortho first.

I have no problem with anyone getting first-line access to patients (widely interpreted as access to their insurance money). I believe in a completely open market, where people are free to see whoever they want, with whatever belief system they want. If you want to go see a shaman and have him wave a chicken head over your back while he chants and someone plays a tambourine in the background, feel free.

You can go ahead and see the patient first, save me the time. If it doesn't work, I'll take it from there. If what I do doesn't work, there's always other people they can see.

The problem, for any field, is sorting out the charlatans from the good guys. Usually it's a matter of opinion. We are all in our jobs to make money. Anyone who says otherwise is FOS. But greed often makes otherwise rational people do stupid things. And medical treatments will always follow the money.

 

[Booyamc]

The thing with allowing people to see whoever they want first is that medicine is not a free market and physicians are the only health professionals not allowed to unionize, there is no collective bargaining effort when it comes to the government and insurance companies

I'm all for letting people do what they want but do you really want people bringing their kids to a chiro or shaman when they suspect some physical developmental delays?

 

[MotionDoc]

I believe you misinterpret what I said. I feel PT's will need to establish themselves (in the public eye) as the go-to guys for MSK problems, not that they have a knowledge deficit in this area. They will simply have to market themselves successfully enough to change people's perception of where to go when you hurt your back, pull a muscle, etc. Right now, when they get an acute MSK injury, most people decide to go to their PCP, an ortho or a chiro. PT's will need to market well enough to break that thought line.

It's the same problem we Physiatrists face in dealing with referrals. PCPs in general are so ingrained in the thought of "MSK = ortho" so every problem we can manage goes to ortho first.

I have no problem with anyone getting first-line access to patients (widely interpreted as access to their insurance money). I believe in a completely open market, where people are free to see whoever they want, with whatever belief system they want. If you want to go see a shaman and have him wave a chicken head over your back while he chants and someone plays a tambourine in the background, feel free.

You can go ahead and see the patient first, save me the time. If it doesn't work, I'll take it from there. If what I do doesn't work, there's always other people they can see.

The problem, for any field, is sorting out the charlatans from the good guys. Usually it's a matter of opinion. We are all in our jobs to make money. Anyone who says otherwise is FOS. But greed often makes otherwise rational people do stupid things. And medical treatments will always follow the money.

While I largely agree with your post, I have to disagree with your final statement regarding money. No one went to PT school for the money. Indeed, many suck up 150K+ in debt in order to eventually make somewhere around 80K. Most PTs truly love their job and MANY are second career therapists that leave six figure jobs and take on the debt of PT school; in my PT class alone (N=32), we have 2 such individuals.

Obviously I can't speak for every physical therapist, but a large part of the push for added education has to do with a nagging feeling across the profession that we can do better by a patient through not only increased clinical expertise (via PT residencies and specialty certifications), but also through increased didactic education...again, not to diagnose or treat pathology, rather to recognize what is not in our realm of expertise and properly refer to yourself, a surgeon, a psychiatrist...whomever.

I mentioned this on the PT forum, but will say it again here: PTs, by the very nature of their work, spend the most time with patients. As such, we have a unique opportunity to assess the subtle changes in a patient's condition or pick up on important findings that may have not presented at the time of evaluation. With this in mind, a better educated PT strengthens the rehabilitation team, would you not agree?

 

[PMR 4 MSK]

While I largely agree with your post, I have to disagree with your final statement regarding money. No one went to PT school for the money. Indeed, many suck up 150K+ in debt in order to eventually make somewhere around 80K. Most PTs truly love their job and MANY are second career therapists that leave six figure jobs and take on the debt of PT school; in my PT class alone (N=32), we have 2 such individuals.

And no one goes into teaching for the money either (disclosure: I married a teacher ). But they expect to be paid for their services commensurate with their training and expertise, as well as with the market in general.

I have never once heard anyone, in any field say "No, wait. That's too much money! Pay me less!"

We work to get paid. Otherwise it's a hobby. The smart people get jobs they enjoy. The adventurous ones go into business for themselves.

I've told many people in my life, and every single person I have ever interviewed to work for me this: Life is too short to work a job you do not like. If you do not look forward to going to work, you need a new job, new training or a new education. This is America and all of it is available to anyone who wants it. You just have to be willing to do what it takes to get it. If you truly enjoy your job, how much you are being paid is not important.

If you need your job to pay your bills, you are working. If you have enough money from a previous job or inheritance that you don't need to be paid, you are not working, you are entertaining yourself with a hobby. Don't we all wish we had it that good?

 

[MotionDoc]

And no one goes into teaching for the money either (disclosure: I married a teacher ). But they expect to be paid for their services commensurate with their training and expertise, as well as with the market in general.

I have never once heard anyone, in any field say "No, wait. That's too much money! Pay me less!"

We work to get paid. Otherwise it's a hobby. The smart people get jobs they enjoy. The adventurous ones go into business for themselves.

I've told many people in my life, and every single person I have ever interviewed to work for me this: Life is too short to work a job you do not like. If you do not look forward to going to work, you need a new job, new training or a new education. This is America and all of it is available to anyone who wants it. You just have to be willing to do what it takes to get it. If you truly enjoy your job, how much you are being paid is not important.

If you need your job to pay your bills, you are working. If you have enough money from a previous job or inheritance that you don't need to be paid, you are not working, you are entertaining yourself with a hobby. Don't we all wish we had it that good?

Well said.

Still, I take offense to the notion that the current struggle in the realm of PT is just to line our pockets. It may not be your personal opinion, but it is a justification commonly used by those who oppose the current trends in PT to bash any legitimacy to the notion of these changes potentially being of benefit to everyone involved.

With various professions pushing the lines of physician care (and may I add that not all their claims are equally valid), I understand the reaction but simultaneously disagree with the assumption that if these changes were to come to fruition, it would automatically translate into something negative for the profession. If we truly believe the mantra that patient care is a team effort, let's not forget that a team is only as strong as it's weakest link.

 

[Booyamc]

I take back what I said....people in their lay knowledge should not go directly to who they think best....there are reasons that there are licensing exams and residency requirements...medicine used to be a set up shop kind of deal until science caught up with it and realized that damage was being done..medicine became evidenced based and government bodies stepped in...should we go in the reverse fashion now? Where a pt sees first a PT, OD, NP and anyone else who has lobbied and marketed themselves enough as pseudo physicians....these blurred lines of practice scope and doctorates in every health field which were originally a supportive field of the practice of medicine, rather than attempting to practice medicine itself should not only worry dr's for their profession but pt safety as well...history repeats when their training is seen as inadequate and people start dropping and becoming worse off then when they came in

 

[Booyamc]

That is some nice rhetoric motiondoc, but human nature and the efforts of other supportive healthcare fields shows it to be otherwise

 

[MotionDoc]

I take back what I said....people in their lay knowledge should not go directly to who they think best....there are reasons that there are licensing exams and residency requirements...medicine used to be a set up shop kind of deal until science caught up with it and realized that damage was being done..medicine became evidenced based and government bodies stepped in...should we go in the reverse fashion now? Where a pt sees first a PT, OD, NP and anyone else who has lobbied and marketed themselves enough as pseudo physicians....these blurred lines of practice scope and doctorates in every health field which were originally a supportive field of the practice of medicine, rather than attempting to practice medicine itself should not only worry dr's for their profession but pt safety as well...history repeats when their training is seen as inadequate and people start dropping and becoming worse off then when they came in

I completely agree with your reasoning, but not your conclusions. I can not speak for other health practitioners, but physical therapists do not care to be pseudo physicians...in fact, the only thing really similar in practice is that we treat the same human body and as of recently we both have doctorates. However, a gymnastics coach works with the same human body, and a neurobiologist both has a doctorate and works with the same human body. Are the lines blurred between these professions?

The problem, in my opinion, stems from lack of communication and inter-profession understanding. First, many physical therapists really can't explain the changes to the profession in a cohesive manner. Second, many physicians see things like "imaging rights" and "direct access," and automatically assume take over. My PT program is lucky enough to have physicians intimately involved in the development and teaching of the curriculum (I can't speak for all programs, but this is not an anomaly). Just to make this clear, these physicians are not crocks we convinced to lend credibility to the program (which when I previously brought this up on these forums was accused of), rather among the best in the area, if not the nation. Because of this, I am lucky enough to see both sides of practice and fully understand that although there is overlap, there are clear boundaries to the professions. Because many do not have this same privilege, I try to clear confusion whenever possible...sometimes successful, sometimes not.

Back to your post: I agree that a patient should see an authority for their particular issues, and it is also my opinion that it is a healthcare professional's duty to make sure patients know who those authorities really are. Where we digress is that you believe that authority always has to be a physician. I do not have an easy response to this because in theory you will always be able to fall back on for utmost safety, a physician should be seen first. My response then stays away from theory, and will focus on clinical reality. The clinical reality is that the majority of patients seen in the outpatient PT setting are misdiagnosed (or improperly labeled) by PCPs. The clinical reality is that physical therapists are at times the ones who find underlying serious pathology in patients that have been cleared by physicians. The clinical reality is that the literature suggests that PTs are equal in expertise in the management of MSK conditions to orthopods, and superior to other physician specialties. To me, the clinical reality points to the necessity and legitimacy of a strong healthcare team.

Last, not only is PT practice evidence based, physical therapist-scientists are also leaders in the field of rehabilitation research, and successfully contribute to the same knowledge base that medical doctors draw from.

 

[mtm34]

some really qualified physicians in full support of direct access... so far so good

http://www.thepittsburghchannel.com/health/18891143/detail.html

 

[Booyamc]

At least there are stringents...only 30 days before doc consult

 

[Booyamc]

And it's just one orthopod so don't go nuts

 

[SxRx]

I'm a medical student (3rd year) and have practiced as a full time physical therapist for 10 years prior to med school. I'll give my perspective on this for what it's worth.

When it comes to this debate about DPTs, DNP, CRNAs, personally it boils down to the amount of work/time/effort/years of training/and most importantly the level of aptitude it took to get into med school that rubs me the wrong way when non physician professionals call themselves 'doctors'. It is true that it is difficult to get into CRNA programs (and maybe DPT and DNP programs as well). But, it doesn't compare in competitiveness of medical schools. I'm sure DPT, DNP, CRNA programs are tough. But, I doubt the number of hours, the effort, the pressure, examinations, amount of knowledge the student is expected to have compares to medical school level. So, it is natural for physicians to feel (or at least myself) that it is a bit of a short cut these other professionals are taking to be called 'doctors'. Believe me, if physical therapist assistants (PTA) began to call themselves 'therapists' and wanted to perform evaluations (PTAs are not allowed to perform initial evaluations) DPTs will feel the same way. You'll feel that it was much easier to get into PTA programs (offered at community college levels) and they call themselves 'therapists'! If vocational nurses wanted to do things RNs did, I'm sure RNs will feel the same way. MD schools are one of the most if not the most competitive schools to get into in US. I understand that many PTs, nurses get into their professions not because they couldn't get into med school but wanted to be PTs and nurses. But I think even as a therapist I understood that the PT route is the one I chose and I'll be called a PT. When I wanted to be a doctor, I got into a med school and when I graduate I'd like to be called a doctor. So, for non physicians to call themselves doctors doesn't represent who they really are since in our society the word doctor invariably refers to a medical doctor. Perhaps DNPs and DPTs should come up with another term for their title....why a 'doctor' necessarily?

As for direct access by PTs, this is what I think. Even up to 2 1/2 years ago, one of the most prestigious DPT programs in the country (USC) didn't have the level of clinical training medical students get as 3rd/4th year med students and certainly nothing like the minimum 3 years of residency all MDs do. The training med students get as 3rd/4th year med school doesn't even compare to the training that DPT student from USC was getting. Clinical training in PT did not (unless it has changed int he past 2.5 years) have a governing body like the LCME/ACGME for MDs that oversees and places a standard to ensure certain level of competency. PT clinical education for that particular USC DPT student was at a community hospital working with a staff PT who was not a DPT, without any standardized method of examinations, or standardized check offs of clinical skills. There is APTA that governs PT practices. But, standards placed by APTA is nothing like what LCME/ACGME places on med students. A DPT student being trained by a non DPT therapist should tell you something. In addition there was no required residency. If a student chose to do a neuro or ortho residency they could. It was 1 year long in length. So her clinical training was far inferior to what even a 3rd/4th yr med students go though plus she didn't have to do a residency. Personally, I had about 6 months of rotating through 3 different hospitals or outpatient clinics (so about 2 months at each facility). There was nothing standardized or overseeing of quality of education by anyone. Someone can correct me if things have changed. One more thing about the level of competency some DPT ortho residency may proclaim. Orthopedic skills for physical therapists entail evaluating many MSK issues. One of the issues they'll likely deal with is spine issues. There is no way on earth you can even be 25% competent after a year of residency in evaluating and treating these issues. It takes years and years of studying, working with patients, feeling what normal feels like vs. abnormal ...etc etc.... It's not like looking at a lab value and determining that a patient has V/Q mismatch. Ortho for physical therapy is much more of an art than it is for medicine (I'm sure medicine is very much an art as well) I highly doubt that a graduate of even a ortho residency of a DPT program can properly evaluate and treat even the most straight forward MSK issues. I'm not stating that MDs are perfectly trained after their residencies. I have no idea. I haven't gone through it yet. But, training/residency programs are nationally accredited and governed while PT clinical training isn't. So, although I LOVE the profession of physical therapy and believe that physical therapists have an important and significant role in healthcare, I do not believe the level and quality of clinical training lends the profession to direct access care.

 

[mtm34]

SxRx- I'm a DPT student and I appreciate the honest post- if you don't mind me asking why did you get out of PT? What area of the country did you practice in and what setting were you in? Thanks for your time.

 

[MotionDoc]

1) I don't care about being called doctor (and 95% of PTs I know don't care). With that said, the DPT is a clinical doctorate (read a few posts above regarding my take about the degree)...if you like it or not.

2) While I perfectly agree a level of standardization in clinical training is necessary, I couldn't disagree more with your conclusion. PTs of all levels have already demonstrated excellent orthopedic (especially biomechanics) and neuromuscular evaluation skills. Peruse the literature and you will see that they are equal to the competency of orthopods and superior to non-orthopedic specialties. With this in mind, based on your premise that the level of PT clinical competency does not warrant direct access, neither should physicians. I guess those with LBP are out of luck?

3) If I was only 25% competent in treating LBP (and other ortho issues), I wouldn't have passed my orthopedic clinical. Indeed, as a student I am expected to successfully manage 100% of non-complex patients, and get a consult for those trickier.

4) I respect your opinion, but I warn you not to judge an entire profession based on the experiences of a single individual... My program does have standardized clinical training, and all my outside clinical affiliations have their own standardized objectives.

5) In my opinion, a one year (actually 13-18 months) PT residency is perfectly acceptable. You have to realize that when you compare PT to MD, you are comparing apples to oranges (I like apples better ). A PT residency gives a PT a high level of expertise in a single area of rehabilitation (ortho, neuro, geriatrics, women's health...). A MD residency must prepare the future physician for much more...

6) This logic also applies to the training of a PT vs. MD. A physicians breath of knowledge regarding the human body is second to none (no one could disagree). But a PTs knowledge of the NMSK system is also second to none. Sometimes I feel that many will never be satisfied with a "D"PT unless it was 4+3 yrs like that of medical training...but don't you think that's overkill. For a PT to practice in an autonomous fashion, he doesn't need to be able to differentiate cancer from infection...all he needs is to be able to recognize when LBP is not actually mechanical in nature. If the former were true, then yes, PT training should be 4+3 yrs...but the second is the reality, and thus 3+1 yrs is fine.

 

[DOctorJay]

as a DO, MSPT i'll throw my hat in the ring to comment as a follow-up to SxRx.

i find it very interesting that therapists want to be called doctor now and are training in "residencies" after they receive their degree. a "residency" is a part of medical training in which a physician spends a significant portion of time in the hospital and typically sleeps (or at least attempts to get some sleep) at the hospital thereby "residing" in the hospital. is there anything similar with these PT residencies? then why call it the same thing?

MotionDoc - please provide some references for number 2

in #4 of your post you mention "My program does have standardized clinical training, and all my outside clinical affiliations have their own standardized objectives." That's part of the problem. There is no national concensus with consistent standardized objectives.

#6 in your post is arrogant at best. your training does not put you on the level of a physiatrist or neurologist or orthopedist or neurosurgeon regarding knowledge of the NMSK systems. why would anyone want PT training to be 4+3 as you mention? it's already overkill at a DPT level. your DPT is not much different from my MSPT and you don't get paid a higher salary for the extra education (a DPT can't charge any more for their services than an MSPT or BPT for that matter). why do you keep boiling down the practice of PT to management of LBP? is that all you treat?

I agree with everything SxRx says. perhaps if you went to medical school you'd form a new opinion as well.

 

[rcheeley]

The reason MotionDoc cont's to reference LBP, is because LBP is the area that seems to be the most difficult when recognizing mechanical vs pathological pain, as LBP can often be a sign/symptom not related to the lumbar or thoracic spine.

Obviously other areas of the body can present w/ symptoms that might indicate something of pathological nature, but in many cases they are much easier to regocnize in comparison to the spine.

I would imagine he also refers to this area, because it seems to be the area of "hot topic" in many of the battles between the PT and MD professions - as the spine has been the area of question from the physicians. For exmaple in California, a physician asked the PT "if my mother went to you directly instead of seeing a physician, how are you going to look at her LBP and differentiate if it is mechanical and not of some other origin?"

I'm not arguing, I'm just giving my opinion as to why he keeps referencing LBP.

 

[MotionDoc]

as a DO, MSPT i'll throw my hat in the ring to comment as a follow-up to SxRx.

i find it very interesting that therapists want to be called doctor now and are training in "residencies" after they receive their degree. a "residency" is a part of medical training in which a physician spends a significant portion of time in the hospital and typically sleeps (or at least attempts to get some sleep) at the hospital thereby "residing" in the hospital. is there anything similar with these PT residencies? then why call it the same thing?

1) As you saw, I couldn't care less (and 95% of the PTs I know) about being called doctor. Are you arguing that the DPT isn't a clinical doctorate? If not, then there is no argument.

2) The PT residencies I am familiar with may be misnomers, but that is what the profession calls it. There are plenty of misnomers in society, what do you want me to do about it. My point was that a PT residency isn't similar in breath to an MD residency...but it is rigorous training in a specific facet of physical therapy, thus it is analogous to medical residencies. Between added course work, surgery and various MD observations, clinical training, scholarly activity, and teaching, it amounts to about 80 hours a week, thus our residents do practically "reside" in the building.

MotionDoc - please provide some references for number 2

http://www.ncbi.nlm.nih.gov/pubmed/15773564

http://www.ncbi.nlm.nih.gov/pubmed/15963232?ordinalpos=1&itool=EntrezSystem2.PEntrez. Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.P ubmed_Discovery_RA&linkpos=1&log$=relatedarticles& logdbfrom=pubmed

http://www.ncbi.nlm.nih.gov/pubmed/17138843

http://www.ncbi.nlm.nih.gov/pubmed/17484321

These are from a post of mine on the PT forum...there is much more out there, but:

Similar to not making a diagnosis based on a single test, rather a preponderance of data, do not make a conclusion based on a single study, rather a preponderance of the evidence. I agree that the evidence is not a panacea for the current PT struggle, but the point of these articles are to promote physical therapy specialization and the DPT. I am not sure how long you have been away from the profession, but you have to understand that there is an internal struggle within the profession, and there is a ton of disparity in practice ability.

in #4 of your post you mention "My program does have standardized clinical training, and all my outside clinical affiliations have their own standardized objectives." That's part of the problem. There is no national concensus with consistent standardized objectives.

Yes, and I agree that is a problem...SxRx's post lead me to believe that he believed there was this wide spectrum of training where a PT student could walk away with crap or gold. My post was simply meant to point out that this is not true across the board, and that one individual's experience should not a conclusion make. Personally, my program has taken it upon itself to ensure a high level of clinical training, and it is foolish to believe that only 1 program in the country is doing this...but I can't speak on their behalf.

#6 in your post is arrogant at best. your training does not put you on the level of a physiatrist or neurologist or orthopedist or neurosurgeon regarding knowledge of the NMSK systems.

I see how you can view that comment as arrogant, and perhaps it doesn't capture what I am trying to say. If it read: "ability to manage MSK conditions," instead of "knowledge of" would that be better? That comment is based on the recent body of literature, as well as personal conversations with those PMR docs, orthopedists, and neurologists who have shaped my PT training.

why would anyone want PT training to be 4+3 as you mention? it's already overkill at a DPT level. your DPT is not much different from my MSPT and you don't get paid a higher salary for the extra education (a DPT can't charge any more for their services than an MSPT or BPT for that matter). why do you keep boiling down the practice of PT to management of LBP? is that all you treat?

1) The number one argument made by physicians is that "PT training is not as long or rigorous as MD training..."

2) Unfortunately I have to disagree: you are wrong that the DPT is not much different from the MSPT. I don't know your background or how you came to that conclusion, so I won't judge, but the vast majority of MSPTs I have met and worked with would also disagree. This statement leads me to believe you haven't read my posts in this thread regarding that particular argument... If we are to have a discussion, I would appreciate that you look that over so that I don't have to repost.

3) From your last point, it sounds like you believe that an individual's worth can be determined from what he is paid. Is that a correct interpretation? I hope not.

I agree with everything SxRx says. perhaps if you went to medical school you'd form a new opinion as well.

Well, I can't speak to the subtleties of medical training, but coming from a family of physicians and having been on an MD/PhD tract practically my entire life (you can find my story on the PT forum if you care), I believe I have the perspective you suggest I gain before forming my opinion. Although you are a former PT, and at the very least that is a valuable perspective that your colleagues do not share, you do not have the perspective of a current PT living this struggle daily, so please do not be so quick to judge.

 

[DeigoT]

I'm a medical student (3rd year) and have practiced as a full time physical therapist for 10 years prior to med school. I'll give my perspective on this for what it's worth.

When it comes to this debate about DPTs, DNP, CRNAs, personally it boils down to the amount of work/time/effort/years of training/and most importantly the level of aptitude it took to get into med school that rubs me the wrong way when non physician professionals call themselves 'doctors'. It is true that it is difficult to get into CRNA programs (and maybe DPT and DNP programs as well). But, it doesn't compare in competitiveness of medical schools. I'm sure DPT, DNP, CRNA programs are tough. But, I doubt the number of hours, the effort, the pressure, examinations, amount of knowledge the student is expected to have compares to medical school level. So, it is natural for physicians to feel (or at least myself) that it is a bit of a short cut these other professionals are taking to be called 'doctors'. Believe me, if physical therapist assistants (PTA) began to call themselves 'therapists' and wanted to perform evaluations (PTAs are not allowed to perform initial evaluations) DPTs will feel the same way. You'll feel that it was much easier to get into PTA programs (offered at community college levels) and they call themselves 'therapists'! If vocational nurses wanted to do things RNs did, I'm sure RNs will feel the same way. MD schools are one of the most if not the most competitive schools to get into in US. I understand that many PTs, nurses get into their professions not because they couldn't get into med school but wanted to be PTs and nurses. But I think even as a therapist I understood that the PT route is the one I chose and I'll be called a PT. When I wanted to be a doctor, I got into a med school and when I graduate I'd like to be called a doctor. So, for non physicians to call themselves doctors doesn't represent who they really are since in our society the word doctor invariably refers to a medical doctor. Perhaps DNPs and DPTs should come up with another term for their title....why a 'doctor' necessarily?

As a former nurse, I couldn't agree more with the above statement. Although I trained as an NP, I choose the MD route instead of the DNP. I wanted the avenue that would provide the very best knowlege base. After recently graduating, a former NP colleague actually emailed me to let me know I had wasted my time and money going to medical school because she had registered for an online DNP program which will be 1/4 the cost and she will be able to continue working fulltime. Most importantly, she wanted me to know "there will be no difference between myself and her in a few years as ANA is going to make sure that all DNPs will be able to introduce themselves to patients as doctor x and patients wont know the difference." Now, I don't know of many who go through the hard work of medical school simply for the doctor title, but there is definitely something wrong with what's going on.

Amazingly I remember years ago when hospitals in NY attempted to use techs to take over many of the nursing roles. Some even propose they introduce themselves as 'nurse'. ANA put a lot of money into commercials which told patients of the move to have undertrained staff who are not "real nurses" parade around as such and this may put their lives at risk because the training is not the same. Uhm, sounds familiar? The commercials stated "when you go to the hospital, in order to make sure you are getting the best care, ask for a real nurse, as for an RN." That is exactly what patients did and the plan was scrapped. Perhaps AMA could learn something from nurses considering what physicians are now facing.

 

[MotionDoc]

As a former nurse, I couldn't agree more with the above statement. Although I trained as an NP, I choose the MD route instead of the DNP. I wanted the avenue that would provide the very best knowlege base. After recently graduating, a former NP colleague actually emailed me to let me know I had wasted my time and money going to medical school because she had registered for an online DNP program which will be 1/4 the cost and she will be able to continue working fulltime. Most importantly, she wanted me to know "there will be no difference between myself and her in a few years as ANA is going to make sure that all DNPs will be able to introduce themselves to patients as doctor x and patients wont know the difference." Now, I don't know of many who go through the hard work of medical school simply for the doctor title, but there is definitely something wrong with what's going on.

Amazingly I remember years ago when hospitals in NY attempted to use techs to take over many of the nursing roles. Some even propose they introduce themselves as 'nurse'. ANA put a lot of money into commercials which told patients of the move to have undertrained staff who are not "real nurses" parade around as such and this may put their lives at risk because the training is not the same. Uhm, sounds familiar? The commercials stated "when you go to the hospital, in order to make sure you are getting the best care, ask for a real nurse, as for an RN." That is exactly what patients did and the plan was scrapped. Perhaps AMA could learn something from nurses considering what physicians are now facing.

Since Physical Therapy always gets thrown back in with the "doctoring" of other professions, let me make this clear: The large majority of PTs do not wish to be called doctor, and those that do would largely only make that distinction in their own outpatient PHYSICAL THERAPY clinic or in an academic setting.

The PT profession going to the doctorate was to enable the profession to practice in an autonomous fashion. Indeed, most MSPTs were already practicing under pseudo-autonomy...under the guise of a usually useless script from a PCP. The backlash then with the push to autonomy was that MSPTs did not have the training to pick up the yellow or red flags that warranted immediate medical attention...THUS, the introduction of the DPT, and with it the background training necessary to screen for underlying pathology (note: not specific, that's the doc's job).

Disclosure: I couldn't care less about the other "doctoring" professions as I don't know much about their ideology. BUT, if you are going to group PTs with them without giving it much thought, I warn you that you are doing both professions a disservice.

 

[SxRx]

Some of the most frequent responses I read when it comes to PT's feeling like PT autonomy makes sense rather than getting a referral from a PCP is this:

PCP's referral normally just says "PT to eval and tx" or "Low back pain-eval and tx".
PT's point is that if the referring docs have no clear idea on what is wrong with the patient and refer pts for the PTs to figure out, why not just have the PTs have direct access care? My answer (and this answer is the same position I held when I was a PT) is that most of PTs themselves do not know clearly what is going on with the patient's back pain. Back pain really is one of the mysteries of medicine. A lot of people have it and aside from occasional success stories by PTs, chiropractors, medications really are the way most people deal with low back pains. How many times have you run into people who say stuff like "I've had back pain for years. I've seen my doctor, physical therapist and a chiropractor and no one really seems to be able to help me much. So, I take meds and deal with it." PTs talk about facet joint issues, stenosis, strain, etc etc that cause these pains (not just low back pain but neck pain and just about any type of MSK pain you can think of) and how they "treat" these. What PTs can do for these pain issues is not treatment. The techniques we use have not been proven to cure, speed up recovery time let alone have sufficient % of therapists being able to dx the problem properly. There are so many MSK pain related issues that frankly no one can really do anything about. So, for some PTs to say things like "MDs give us useless rxs" is unfair. PTs should be aware what chiropractors think of us. Chiropractors think of PTs as being jokes in terms of being able to diagnose and treat neck and back pain issues. In my personal experience working at well known outpatient clinics and hospital outpatient clinics I really have to say maybe 1-2 out of 10 PTs can differentiate causes of back pain. Even when they can differentiate various causes it's not certain since as mentioned back pain/neck pain issues are such mystery. I know and I can confidently say this, that there aren't PTs (or MDs and chiros) who can dx and treat low back pain using conservative measures effectively. How can I make such a statement? If one could he/she'd be a millionaire and be on 60 minutes. Many back pains simply can't be 'treated' and cured. Sometimes they linger on for years, or life. Sometimes (most of the times) they go away with in a few weeks to a month. And believe me, they go away even without the help of anyone...MD or a PT. To this point of humility, it refers a bit more to the PTs. I don't find too many MDs who talk as if they are highly effective in back pain diagnosis and treatment. But, I do find many more PTs who claim they can and know what they are doing while the outcome really isn't there. And in case someone is tempted to list a link of PT journals on how my statement is wrong, I'd like to remind you what the level PT journals are held in the medical research community. Some of my statements may sound strange coming from a PT. I just know what PTs can offer and what limitations we have. As I study medicine, I'm humbled often.....we just don't know that much. We know a lot and of all medical professionals we know the most. But, we will never know even close to 90% of what really goes on in our body, in my opinion.

When PT students and people in PT academia are buried in their work, pride themselves in techniques of tx and eval, what they lose sight of is the outcome. For every 1 patient who has had success with PT for back pain, I meet 3 who has had better success with chiros and 30 who couldn't find relief anywhere. So, having a little more humility will suit everyone, PTs and MDs.

And one more thing. PTs just wanting to be able to do x, y, z and don't care about being called a 'doctor' is a bit short sighted. When people in anything call for changes often the changes start off with a small step. They have no ill intention to take anyone's territories over, or be called a 'doctor' or force anyone to do anything. But, things change as time goes by. Without a doubt things change. This isn't even a question. So, yes, if PTs or DNPs get called doctors in 20 years it will be prescribing previliges/ hospital roundings/ wanting to be able to apply for MD residencies. Who knows what will happen. I mean, these examples I gave are silly. But, not out of the question. I mean, 30 years ago did we even think that we could be having a thread like this about how nurses are introducing themselves as doctors?

Again, it all comes down to other professionals wanting to do some of what doctors have been doing and doctors feeling territorial. If other professionals want to do some of what doctors do in addition to what they do, get an MD degree and renew your previous RN or PT degrees and do both. Whether you admit it or not, the MDs will feel like you are taking a short cut to the title and practice scopes held by doctors. Again, think about how you'd feel if vocational nurses and PT assistants wanted to start forming their organizations and wanted to do many of what RNs and PTs do.

 

[Socrates25]

At least there are stringents...only 30 days before doc consult

Dont hang your hat on that. Once the door is open and the camel has his nose under the tent, you are screwed.

Watch that "restriction" magically change over time. 30 days at first, then 90 days, then 6 months, then 6 years, then.... never.

 

[Prof Moriarty]

Great discussion. Interesting to hear the perspectives of SxRx, MotionDoc, et al.

I don't care about being called doctor (and 95% of PTs I know don't care).

MotionDoc, I appreciate the thoughtful nature of your posts. But your moniker begs the question: if you don't care about being called "doctor" then why is your screen name "Doc" anything?

As for the need for referral, the point is that physicians have the training, knowledge, and skill to rule out other etiologies. The patient that presents with back (or other) pain could go a lot of different directions, only one of them being PT. I'm guessing you might argue that PT's are trained to recognize this and make appropriate referrals too. But the training is undeniably different. The old adage that "you don't know what you don't know" rings especially true when you go to medical school, as SxRx noted. I don't mean you specifically - I mean the PT community in general. I don't doubt for a second that there are some brilliant PT's (with and without doctorate degrees) and that some of them have a very high level of knowledge in this regard, but they are the exception, not the norm.

Now, should it be a law? I don't know. But I think it is a prudent approach to consult a physician first before a PT for any medical issue.

 

[MotionDoc]

Great discussion. Interesting to hear the perspectives of SxRx, MotionDoc, et al.

MotionDoc, I appreciate the thoughtful nature of your posts. But your moniker begs the question: if you don't care about being called "doctor" then why is your screen name "Doc" anything?

That does seem rather hypocritical doesn't it. I am in a dual degree program pursuing a PhD in Biomechanics and Movement Sciences (thus the "motion") in addition to the DPT.

As for the need for referral, the point is that physicians have the training, knowledge, and skill to rule out other etiologies. The patient that presents with back (or other) pain could go a lot of different directions, only one of them being PT. I'm guessing you might argue that PT's are trained to recognize this and make appropriate referrals too. But the training is undeniably different. The old adage that "you don't know what you don't know" rings especially true when you go to medical school, as SxRx noted.

The training is different because medical training is by far superior when it comes to ruling out other etiologies (undeniable). But I don't think that is the real question here. I believe all it boils down to is a PT being able to rule out a mechanical cause (which is undoubtedly his expertise), not rule in the "other." This is akin to some test having high sensitivity but poor specificity.

SxRx, I wholeheartedly agree with your sentiments regarding the medical communities utter lack of knowledge when it comes to treating the spine and other MSK issues, but just as a correction, this is not news to PTs. The PT literature is swarming (and has been) with articles describing the "failures of the pathology model" and the call for new, evidence-based treatment classifications. My PT program has even completely dropped discussing pathology when it comes to treating the spine, and has instead adopted outcome based clinical prediction rules and rehabilitation protocols. The program runs clinics for all PTs, Physicians, Chiros in the region, discussing the gross failure of conservative treatments directed at specific pathology...orthopedic surgeons that are intimately involved in my PT program discuss the gross negligence they have seen when it comes to some of the surgeries done for the same topic. My point: you are correct, but don't think this is unheard of in the PT community. Are there the PT gurus out there that talk as if they know it all? Yes. Are there PTs that have bought into this and in turn treat as if they know it all? Yes. But do you know how many physicians I have also heard speak about what McKenzie says happens with repeated motions as if it were absolute fact? The problem you speak about is pervasive across all medical professions, and PT is just as evidence based and outcomes oriented as you described the physician community.

As far as your comment regarding the level at which PT journals are held within the medical research community, please elaborate... If you are referring to the low impact factor, my response is that JPT is a niche journal with a tiny fraction of scientists doing that type of research...how can you possibly expect a large number of citations? For the type of studies they perform, the quality is as good as possible. Most PT-Scientists that publish in the PT literature are well published in many high impact journals.

 

[MotionDoc]

PT isn't the treatment plan for all MSK issues, a pt may be reffered for surgery or medication or some other lifestyle change...the PT isn't trained to make these kind of referrals, why would the pt go to a PT before their doctor? And the pt is even less qualified to determine appropriate treatment, so please don't use the excuse that they know what's wrong and what they need

Do you know how many times surgeons have asked us if the patient is now ready for a surgery? Lines of constant communication are vital. In my opinion, why should meds and/or surgery even be an option if PT is effective? If it isn't effective, then the patient is referred out. I may not understand your point, because this seems a non-issue to me.

Despite your PhD candidacy, you'd be very misleading in a clinical setting to be called "doc" and why refer to yourself as one before you even get one?

So is this forum a clinical setting? Are patients reading this? If they are, are they going to be confused that I am a physician? If so, did they not see the PT/PhD immediately after my name? Are you trying to pick a fight?

There are many other "niche journals" that have high impact factors and MSK issues aren't very niche anyway, if it was quality research others would be citing it

Have you even read a PTJ article? Many of those authors consistently publish in JAMA, Nature, Stroke, Archives, etc. So some of their work is shotty and some of it is quality? Makes perfect sense since science is so erratic and not exactly a precise *science*? And rehabilitation is a niche. For motion analysis research, for example, I can count the number of labs in the world on my fingers and toes. I am still convinced you are trying to pick a fight...especially since your name resembles the name of an individual who has been "banned for trolling" on the PT forums twice already.

I think in some pts for some MSK issues in may even be detrimental for a patient to start PT, I'm sure a PMR person could find some

Agree.

 

[axm397]

This is an interesting thread and it's good to see all the discussion it has generated. It's also nice to see it has not degenerated to a lot of name calling and personal insults.

I work with PTs both in-house and out - private practice and hospital based. I have a good working relationship with a lot of therapists around town and I talk to them on the phone and have lunch with them to discuss patient cases. I also educate the patients about PT - that they should be having mostly "Active" PT and not so much time on modalities and passive PT. I also tell them that if they are one of eight other patients being multiplexed with modalities, to run. If they only see the PT for the evaluation then work with a PTA the rest of the time, I tell them to call me. I rarely approve requests for TENS units and home traction units from PTs. I also will change PTs if the patient doesn't see some kind of improvement within 4-5 sessions. I dont' like patients wasting their time and money on PT that lasts on and on.

I have had some therapists blatantly ignore my prescription - I ask for McKenzie method, they send me a note with nothing about directional preference, derangement, restrictions, etc. I even have patients call to ask if the therapists do McKenzie therapy and they will lie and say yes. I have pulled patients out of therapy because of this. I have had patients quit PT crying because although I asked for aquatherapy (because the patient has a lot of somatic issues and has a lot of myofacial pain and she likes the water) - they insisted on land based PT and even went as far as having an internal pelvic therapist talk about internal PT for her SI pain. The therapist apparently told the patient that the doctor doesn't know anything that they decide what they want to do. They are so used to docs just writing eval and treat that when they do get a detailed script, they just disregard it assuming I don't know anything about PT.

I do think that PCPs in general do not get educated about MSK issues enough. I teach CME courses to PCPs on MSK topics and peripheral injections. During that lecture, I educate them on what to look for in a PT, to not blindly sign off on requests for DMEs, and to not renew a PT script unless the patient is making progress. In practice, I send a detailed note back to the PCP for each referral and will follow up with a phone call as needed.

The PTs I work with - whether they are for or against direct access - appreciate that they don't have to explain everything on their report and I basically hand them a patient on a "silver platter". I also get the patient to "buy in" to the PT process prior to starting - which helps the therapist since the patient is more motivated. 80-90% of my spine patients get better without surgery. Most don't even need injections. I rarely write for opioids and manage most patients with NSAIDs, muscle relaxants, neuropathic pain agents, and medrol dose pak. I tell the patients that medications and injections are temporary but the benefits of PT will last long term.

That being said, I have diagnosed conditions such as OPLL - which would have been missed by most PTs and chiros - who had to be referred to surgery immediately. I have also diagnosed multiple myeloma and other oncological processes causing back pain, Compression fractures with posterior retropulsion causing radicular pain, high grade unstable spondylolisthesis, etc.... All of these patients would not be good candidates for PT. There are quacks in every healthcare field including medicine and patients who are vulnerable or gullible will fall for them. There are PTs who own gyms/spas where they do nothing but sell devices, charge for modalities, and keep patients for months and months on "maintenance" PT by a PTA.

If patients choose to go to a therapist or a chiropractor or an acupuncturist, or a herbalist and there is delayed diagnosis or catastrophic outcome, then those specialists and patients have to deal with the consequences. I will have no problems testifying about a missed radiological finding or physical examination/history element. Patients should be educated about the risk they are taking by avoiding a physician - but the same patients who would go to a PT first without seeing a doctor will also go see a chiro, an acupuncturist, a holistic healer, etc. without first seeing a doctor as well. So to me, direct access doesn't mean much. The patients who know to see me first will continue to see me first. The referring docs who know to refer to me first will continue to refer to me. If a therapist or anyone else for that matter wants to call him/herself a "doctor" and defraud the system, let him/her deal with the consequences.

 

[MotionDoc]

This is an interesting thread and it's good to see all the discussion it has generated. It's also nice to see it has not degenerated to a lot of name calling and personal insults.

I work with PTs both in-house and out - private practice and hospital based. I have a good working relationship with a lot of therapists around town and I talk to them on the phone and have lunch with them to discuss patient cases. I also educate the patients about PT - that they should be having mostly "Active" PT and not so much time on modalities and passive PT. I also tell them that if they are one of eight other patients being multiplexed with modalities, to run. If they only see the PT for the evaluation then work with a PTA the rest of the time, I tell them to call me. I rarely approve requests for TENS units and home traction units from PTs. I also will change PTs if the patient doesn't see some kind of improvement within 4-5 sessions. I dont' like patients wasting their time and money on PT that lasts on and on.

I have had some therapists blatantly ignore my prescription - I ask for McKenzie method, they send me a note with nothing about directional preference, derangement, restrictions, etc. I even have patients call to ask if the therapists do McKenzie therapy and they will lie and say yes. I have pulled patients out of therapy because of this. I have had patients quit PT crying because although I asked for aquatherapy (because the patient has a lot of somatic issues and has a lot of myofacial pain and she likes the water) - they insisted on land based PT and even went as far as having an internal pelvic therapist talk about internal PT for her SI pain. The therapist apparently told the patient that the doctor doesn't know anything that they decide what they want to do. They are so used to docs just writing eval and treat that when they do get a detailed script, they just disregard it assuming I don't know anything about PT.

I do think that PCPs in general do not get educated about MSK issues enough. I teach CME courses to PCPs on MSK topics and peripheral injections. During that lecture, I educate them on what to look for in a PT, to not blindly sign off on requests for DMEs, and to not renew a PT script unless the patient is making progress. In practice, I send a detailed note back to the PCP for each referral and will follow up with a phone call as needed.

The PTs I work with - whether they are for or against direct access - appreciate that they don't have to explain everything on their report and I basically hand them a patient on a "silver platter". I also get the patient to "buy in" to the PT process prior to starting - which helps the therapist since the patient is more motivated. 80-90% of my spine patients get better without surgery. Most don't even need injections. I rarely write for opioids and manage most patients with NSAIDs, muscle relaxants, neuropathic pain agents, and medrol dose pak. I tell the patients that medications and injections are temporary but the benefits of PT will last long term.

That being said, I have diagnosed conditions such as OPLL - which would have been missed by most PTs and chiros - who had to be referred to surgery immediately. I have also diagnosed multiple myeloma and other oncological processes causing back pain, Compression fractures with posterior retropulsion causing radicular pain, high grade unstable spondylolisthesis, etc.... All of these patients would not be good candidates for PT. There are quacks in every healthcare field including medicine and patients who are vulnerable or gullible will fall for them. There are PTs who own gyms/spas where they do nothing but sell devices, charge for modalities, and keep patients for months and months on "maintenance" PT by a PTA.

If patients choose to go to a therapist or a chiropractor or an acupuncturist, or a herbalist and there is delayed diagnosis or catastrophic outcome, then those specialists and patients have to deal with the consequences. I will have no problems testifying about a missed radiological finding or physical examination/history element. Patients should be educated about the risk they are taking by avoiding a physician - but the same patients who would go to a PT first without seeing a doctor will also go see a chiro, an acupuncturist, a holistic healer, etc. without first seeing a doctor as well. So to me, direct access doesn't mean much. The patients who know to see me first will continue to see me first. The referring docs who know to refer to me first will continue to refer to me. If a therapist or anyone else for that matter wants to call him/herself a "doctor" and defraud the system, let him/her deal with the consequences.

Glad to have you on board with this discussion.

The first time the DPT was ever introduced to me, I immediately said "why?" I assumed that every physician was like you, and that the DPT was, frankly, pointless. Then the clinical reality hit me. As I went on both MD and PT observations, two things really knocked me off my horse. 1) MDs were consulting PTs because they were completely in the dark regarding the best treatment course for certain MSK patients. I remember speaking with these physicians, and can recount how they spoke so highly about physical therapy and trusted those physical therapists to the point that they were genuinely thankful that they could send a patient along with only an "evaluate and treat" script, and were 100% certain that the patient would receive the highest level of care. What I saw later on shocked the bejesus out of me. 2) PTs were suspecting underlying pathology in patients that were 100% cleared by physicians, those patients were referred back and were cleared again by those same physicians. The PTs were not satisfied and recommended another physician consult, leading to these patients admitted or off to surgery after a 1-2 week delay because these physicians couldn't do their job.

Now, if I saw these situations once, or even twice, I would've felt comfortable chalking it up chance...but the prevalence at which I saw this in 6 short months blew my understanding of healthcare out of the water.

Soon after, I met PTs that were once 100% opposed to direct access. Conversations with them revealed that they chose PT instead of medicine because they did not want to deal with medical emergencies...they wanted to perform PT on a completely cleared patient without having to worry about a patient's "cellular" problems as they would call it. But all this changed when they finally got into practice, and saw that this was just not a possible reality: they told me that often times they knew that a certain course of PT prescribed by a physician was ill advised or pointless, and that they were constantly (with limited knowledge of non-MSK complications may I add) referring patients back to physicians with serious underlying pathology that developed during the course of rehab, etc. Their conclusions were that the PT profession had to develop further in order to do right by patients.

My thoughts: If every physician was as skilled and knowledgeable as you axm397, things may have been different. The clinical reality however, demanded that PTs further their education in order to strengthen the healthcare team and provide better care.

In a perfect world: a skilled PT would work with a knowledgeable physician such as yourself in the management of a patient.
The reality: many physicians are glad to dump off patients on PTs (if they admit it or not) because they just don't know how to effectively manage their conditions, and the PT profession responded to this need with the DPT (as I have written about in previous posts).

 

[MotionDoc]

The reality: many physicians are glad to dump off patients on PTs (if they admit it or not) because they just don't know how to effectively manage their conditions, and the PT profession responded to this need with the DPT (as I have written about in previous posts).

This is not to say, of course, that direct access PTs do not work with physicians (whether off the street or from a referral) in the care of complicated patients...

 

[MotionDoc]

I think you overestimate how much this extra 6 months to 1 year in a DPT prepares you to recognize complicated pts

And I think you underestimate it. The current literature suggests I am correct...but I agree, further study is necessary.

And it sounds like more MSK education for PCPs is the answer not direct access/imaging and script rights

Sure, that's a solution. I think my solution is just as good, and if time proves that PTs are capable of successfully managing and referring patients in a direct access environment, then my solution yields the best pop for your buck (allowing physicians to focus on and deal with the serious medical problems...)

I think you would find PTs missing alot more than the physicians you cited, in your personal experience

Sure, that's not my argument.

Any my personal experience has been validated by an entire profession (and a chunk of yours), and again, the literature that does exist on the subject (cited earlier) also supports it.

As much as this seems like a territorial battle, it shouldn't be. We both have the patient's best interests in mind. We can continue to speculate all we want, but I truly believe the literature will eventually force the best conclusion.