In his 11/07/07 blog Brian Ferrie discusses Preview 2020. Preview 2020 is a statement of where the profession is expected to be in 2020. In his blog, Brian asked for opinions about the vision. I have an opinion. It may not be popular. I think someone needs a reality check. I like the idea. I can't buy into it. Nor do I understand what information was used to develop this vision. I would like to have some other issues addressed.
First, I would like to know who was questioned to reach this conclusion. I don't think it was many of us in the trenches providing therapy. My day is a struggle to provide the best care possible, meet insurance requirements while completing my documentation all without running into overtime. I, like most therapists, don't have time for anything else. One problem I see is the amount of education that will be required. The DPT has increased the amount of education to become a therapist. As costs continue to increase, the price becomes prohibitive. Current therapists may feel pressured to pursue the advanced degree. Yes, there are many online programs but at a cost of upwards of $30,000. That's a lot of money if you're barely making ends meet.
Second, our health care system needs a major overhaul. Social Security may not exist by the time I reach retirement age. Baby boomers are beginning to reach retirement age. We haven't begun to feel the effect of that many people entering the health care system creating a need that didn't exist previously. I would rather have emphasis placed on solving this problem. Meanwhile commercial insurances cut reimbursements and limit what they will cover. While practice without referral exists, most insurance companies still want a doctor's prescription before they will pay. That has to be resolved for Vision 2020 to happen. Medicare has recently said it will no longer pay for nosocomial wounds. That means everyone else will as co-payments and deductibles rise further.
Third, I want to know where we're going to get the therapists to treat all the people who will be needing services. Increasing the required schooling may cause individuals to become PTAs or look at other occupations in the therapy world. At the same time, experienced therapists, such as myself, are beginning to reach a glass ceiling. Job descriptions are starting to list a master's degree as a requirement. Some of these therapists are going to leave the work force. Some of us are going to try to stick it out. Eventually it won't be an issue as we'll all have retired. That won't happen in 13 years though.
Finally, I want to know who decided this was in the best interest of physical therapy. I want to know who sat down and said Vision 2020 is better. How was that judgment made? What criteria were used? In Vision 2020 we're moving toward a different model of providing health care. To me it resembles how physicians practice medicine now. Those same physicians are moving away from that model either by limiting the hospitals they admit to or relying on hospitalists to care for their patients. So I'm asking, how is this better? How is a patient going to receive BID treatment if the therapist isn't based at the hospital? How is someone in ICU going to receive treatment if the therapist is only available once a day but that's when something else is going on? I don't see how this is better patient care.
I think therapy will change. It will probably move in this direction. Reaching our Vision will depend on many other things happening first. Change doesn't happen quickly. Vision 2020 may be too optimistic. There will need to be payer sources and enough therapists. True practice without referral will need to exist. The education questions must be answered. Right now I think we need to focus on immediate challenges and move ahead when we're prepared.