The 39th Annual McMillan Lecture: "We Are What We Do"
SAN ANTONIO—Anthony Delitto, PhD, PT, FAPTA, became the 39
TH Mary McMillan lecturer today at the APTA conference, opening his talk to a packed ballroom with a gracious nod to those who went before him. Dr. Delitto serves as professor and chairman of the department of physical therapy at the University of Pittsburgh School of Health and Sciences. He is also the vice president for education and research at the Centers for Rehab Services.
"When I received this honor," he said, "I first looked at the cast who preceded me and I was awestruck. We have all debated hotly on the issues of our time, but there is one thing we do agree on--we are all honored as I am honored to deliver this message and to have my name included with yours."
But it didn't take long for Dr. Delitto's lecture to turn to frank discussion of the challenges the profession faces and how its leaders need to step up to take the reins and turn things around.
Following the theme of his lecture, Dr. Delitto maintained that physical therapists should continually demonstrate their value to the health care field and to patients. "How do we do this? Through public relations, but our overall strategy should be to tell patients that our knowledge and skills match that of those in other fields," he said. "Our message can be so much more convincing that with continuing access to patients, we are not only effective, but also cost-effective."
The PT profession has "a lot to brag about" with regard to presenting compelling benchmarks for National Institutes of health funding, he said. He said 25 percent of NIH funding for rehabilitation research goes to PTs. But does that research get lost in translation once practitioners hit the clinic?
"We place the blame, as in ‘well, the research is never applicable to the clinic,' or [the reverse] ‘well, the practitioners just don't follow the research,'" Dr. Delitto said. "In reality there is room for improved performances in the clinic to start to match evidence-based practice. If the PT profession can make the claim that it is entirely evidence-based, "then adhering to evidence-based practice is not just a nice thing to do, it is also necessary," he said.
The profession needs a new strategy to stop "digging trenches between our clinical and research communities," he said. He quoted Albert Einstein: ‘You don't need to build a bridge unless you've dug a ditch.' We can continue to blame each other but we should instead look to the health care environment in general to see the disparities."
PTs and other practitioners are all affected by the decreases in reimbursement, he said. "Salaries for PT have stagnated while costs of care and education have both gone up. Other professions, physician assistants for example, pay higher salaries for less education and that does not bode well for our applicant pool." PT services are always profitable, Dr. Delitto asserted, but dwindling reimbursement rates across the health care spectrum have resulted in lower salaries.
"Should PT reconsider its strategy?" he asked. "We've been reactionary for too long to impositions on our own practice. We listen too often to those who want to give us too little for our services." But the profession can take steps toward more fair payments, he said.
"First, we can identify areas where we have substantive proof of the effects on PT on overall cost savings. We can also take our arguments to the right level of the food chain. And we can stress that the impact of physical therapy equals cost-effectiveness for health care. Improvement of PT services through better reimbursement will have a positive effect on our recruitment by allowing salaries to rise," he said.
Dr. Delitto also called for more scrutiny of clinical instruction. By chance, the 2008 Jules Rothstein Debate that followed this afternoon centered on this very subject, and Dr. Delitto served as a moderator.
"It is past time for us to look at the clinical instruction component of our educational system, it is at its most vulnerable and frankly is becoming an eyesore," he declared. "How long will we bury our heads and ignore this elephant in the room? Recognizing that we have a problem is actually good news because we're not ignoring it.
Are there barriers to achieving the transition to a doctoring profession for PT? Yes, Dr. Delitto said, but they are not insurmountable. Dr. Delitto used a quote Dr. Rothstein had given him, again from Einstein: "In difficult times lie opportunities."
"We are the stewards of our own profession, and we must solve our clinical education problems," he said. "Remember, the need for a bridge is a sign of a failure in planning."
Dr. Delitto thanked his colleagues in his field, and cited his "phenomenal" faculty at the University of Pittsburgh.