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ADVANCE Perspective: Physical Therapy & Rehab Medicine

'The Next Evolution'

Published July 3, 2013 4:13 PM by Brian Ferrie

Last week's PT 2013 conference in Salt Lake City offered what has become an annual institution -- the 44th Mary McMillan Lecture. Promoting the theme "The Next Evolution," this presentation featured honorary speaker Roger Nelson, PT, PhD, FAPTA. Currently vice president of expert clinical benchmarks at MedRisk Inc., based in King of Prussia, PA, Nelson is also professor emeritus at Lebanon Valley College in Annville, PA, and a former professor at Thomas Jefferson University in Philadelphia. Overall, Nelson has served the profession of physical therapy and APTA for more than 45 years, including 25 years as a commissioned officer in the U.S. Public Health Service. 

ADVANCE sat down with Nelson after the presentation for a short interview about the message he sought to convey as McMillan lecturer. 

"I saw it as a daunting challenge, and I wanted to offer a message that would resonate with attendees," he said. "So I emphasized how we as a profession need to evolve, in terms of research, education and practice. That includes identifying the value of physical therapy, emphasizing the role of data collection and analysis, while also understanding the importance of cost efficiency. Practices must act as businesses."

So did he believe that the presentation went well?

"Yes, and that was very important to me. I spent the past 14 months preparing and I tried to offer a cogent set of points that combined to present a vision for the future. In general, I think we need to ensure that PT isn't known as a 'commodity.' For example, in conversation people will say they have an appointment with their doctor or their dentist. But they usually don't say they have an appointment with their physical therapist. Instead they say a 'physical therapy appointment.' We need to develop the concept that we're a profession, not a commodity. Although progress has been slow in that aspect, I think we're making headway."


I'm not certain as to why a patient seeing a PTA would lessen the importance of attending therapy versus a patient seeing a PT.  I believe it truly comes down to continuity of care more than anything else. We as a profession have gotten so focused on productivity that very few places don't pass patients around from clinician to clinician which I feel isn't only bad for the patient but makes it difficult for each clinician. Every clinician has their own theory outside of the base knowledge each of us leave school with. So I feel that until we all get back into a patient focused profession versus a productivity focused profession, then physical therapy will always be looked at as a commodity.

C Marshall, PTA July 11, 2013 10:36 AM

Patients say they have a doctors or dentist appointment and end up seeing the NP/PA or the dental hygienist.  Not sure how that differs from seeing a PTA in a therapy context.  

Currently therapy is a commodity in certain settings because of the way we are reimbursed for services and we are listed as "allied health professionals", the same as a CNA, in the help wanted section.    

I also have doubts about outcome data boosting reimbursements. Surgeons and dentists will have poor outcomes yet still get premium pay for their services.  If therapy has poor outcomes we are criticized for wasting money.  If we can change that perception then things will get better.  

Jason Marketti July 7, 2013 3:43 PM

As Dean says cost efficiency is the problem.  Clinics make choices in order to survive that result in less that stellar results.  One reason I prefer hospital settings is my patients are usually much more open and respectful of therapy.  Stroke patients intuitively know they need me to get better.  That isn't so apparent in the outpatient world.  

I think we need to focus on the value of PT instead some of the other issues in the spotlight.  It won't matter how many states have practice without referral if no one wants to come to physical therapy in the first place.

I've touched on this in my blog a few times.  But Dr Nelson said it so much better.

Toni July 5, 2013 6:25 PM

I wish I had heard him speak. I agree with all that Dr. Nelson has to say. I looked up commodity and found this interesting definition: "a mass-produced unspecialized product " which would seem to fit the context of which Dr Nelson is speaking.

People don't say they have an appointment with their physical therapist because most of the time they don't, they have an appointment to see the PTA, a rehab aide, or they see a different person on each visit. Yes, we need to function as businesses, but we can't delegate everything to support workers and expect to be recognized as premier professionals. Business models have to change in a way that supports the profession, not just the professional's pocketbook. Cost efficiency isn't about cutting staff or seeing more people per hour. It is about making each patient visit count and working in ways that don't drain the resources of insurers and patients. The cultural shift required is a big one. I hope I get to see it.

Dean Metz July 5, 2013 3:21 PM

Great coverage, Brian! Congrats to Dr. Nelson!

Tom Kerr July 5, 2013 2:35 PM

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