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Toni Talks about PT Today

Vision 2020

Published November 26, 2007 9:29 AM by Toni Patt

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.

19 comments

Hi everyone,

I really enjoyed reading all of your comments, and I really feel like I stumbled across some great information here. Thank you Toni for the article, and thank you all for commenting.

I've been accepted to Chapman University's DPT program. It was no walk in the park to get in. They tell me they received 800 applications for 50 spaces. I need to decide in the next month if I'm going to go or not. Tuition will be $135,000 by the time I graduate. Its intimidating.

Does it bother anyone else that the people in charge of the barriers to entry for the PT profession are the practicing professionals within the profession?

I'm no economist, but my understanding of the situation looks like this:

Higher barriers to entry=lower supply=higher salary for the professionals in the field.

To me, this seems like a conflict of interest, and based on the ever-increasing barriers to entry, it seems that the APTA is taking advantage of the situation to increase their own salaries, by reducing the supply of new professionals into the marketplace.

I'm not a PT yet, but I spent 50 hours observing PTs in Brazil, and 80 hours here in the U.S., and I didn't notice a huge difference in the quality of care.

A very large percentage of Brazilian PTs receive their education for free, due to the fact that Brazilian public universities are tuition free, but the average salary of a Brazilian PT appears to be somewhere around $25,000-30,000 optimistically, according to the best numbers I was able to find. My personal interactions with Brazilian PTs support that. The cost of living is a bit cheaper, but not by much. Mostly, the standard of living is just lower.

So in Brazil, it seems like because they have such low barriers to entry (free education and only 4-5 years of school required) they have a huge supply of professionals, and therefore much much lower salaries.

When you look at the available data for PT salaries around the world, you find that American PTs and Canadian PTs make far more money than any other country. If I'm not mistaken, Canada has an MPT requirement, and their tuitions are extremely high as well.

In Australia, where the cost and standard of living is about the same as the U.S., PTs make an average of only 50,000/yr. Why? Only a BSc is required to practice.

When I was doing my observation hours here in the U.S., I asked several PTs about where I should apply to go to school. One PT I have a lot of respect for, told me "Somewhere cheap! Nobody cares where you graduated from once you start working." That seemed to be the way most of the younger PTs felt about it.

Soooo…. Following that advice, where is the cheapest place for me to get my education if I really want to be a PT?

As far as I can see… It would be Brazil. I can't go to any of the public universities there, but I can do a private school, and it will cost me 3.5 years and $50,000. That's super cheap when compared to the price of my education in the U.S.

I speak some Portuguese, and I'm in correspondence with a reputable school called PUCRS right now to see if we can make it happen.

What does everybody think of this decision? I'm a bit concerned about the requirements of the 2020 Vision, and how they will affect foreign educated PTs without a DPT. I'm sure the PTs in APTA will grandfather themselves into the deal, but I'm just not sure how much experience they will require us to have in order to be grandfathered in. I will likely get licensed in the U.S. in 2019.

I'm not looking forward to leaving my country for 3.5 years. I'm 25. I'll be 29 when I get back. I'm a proud American. I don't want to leave, but I feel very strongly that something is wrong with our educational system, especially for PTs.

I would appreciate everyone's thoughts on this subject.

As far as having autonomy in seeing patients, I think PTs should be allowed that, but I don't know if its going to happen or not. How is the situation with chiropractic?

Grafton Prewett, PT - Student, Unsure December 2, 2014 9:40 PM
Unsure CA

@JOHN : I guess since you are in NJ tells your frustration about foreign PTs. All the foreign PTs I know are either Masters degree or PhD. Also, taking foreign PTs out of picture won't help your situation any. Look around the doctors and physicians around are also foreigner.

Moreover isn't USA called a melting pot of culture. The only difference between the foreigners now and you is that your great grandparents came before them.

Only Native Americans are originals. Everybody else is foreigner on this land.

ciao :)

alia patel October 1, 2014 4:16 PM

Although I understand the need for respect in our profession,  I highly object to the vision that practicing Physical Therapists would be required to obtain their DPT.  I have my BA in PT and graduated at the age of 21.  Now at the age of 42 I need to work many extra hours to pay the bills and begin to put my three children through college.  How will I pay for my own education at the same time and make enough to survive?  This would mean I would probably loose my house.

sharon, pediatrics - PT November 14, 2011 11:37 PM
NJ

Very interesting, this discussion about Vision 2020.

Here are my thoughts on this topic, for what it's worth.

I think the first thing we need to fix, before we can enter a Vision 2020, Direct Access world is that PT's in  general should be able to diagnose their patients. the way it is set up now, the referring party still does this. It is like going to your dentist who then tells you that what's wrong with your tooth looks and sounds like a dentist, but you need to go back to your PCP to get the diagnosis. Incidentally, only the PCP can order imaging studies. Somehow the DC's have been able to acomplish this and that's has helped their direct assess system. they just made the mistake to allienate themselves from the conventional medical system and go in bed with the attorneys to mainly go after PIP patients. Now with the DPT, the DC's are trying to re-establish themselves. But regardless, if we can't diagnose our own patients how can we ever expect insurance companies and CMS to pay for our services without a referral? One interesting point to raise here is the fact that in many West-European countries this has been establishes. In the Netherlands, Germany and England, the PT diagnoses their own patient, have direct access and get paid for their services without a referral, eventhough the highest degree in PT available their is the MsPT.

Second point I would like to raise is how come that while the APTA is pushing for the Vision 2020, it is still allwoing several States to let PTA's practice without havin to pass a state board and acquire a license,

Just a few things to thinnk about,

Jorit Wijnmaalen, DPT, MBA, MTC, CEAS

Jorit Wijnmaalen, PT - Director of Wellness, Physician Practice September 5, 2010 1:55 AM
FL

I have just come across this blog and have found the banter between Allison and John quite interesting.

I have over 14 years of experience as a PT.  I am currently earning my DPT.  I had checked into it a number of years ago and felt that it was a joke and that it was just a way for colleges to get more money.  Then over the years I realized the profession was moving in the direction of the DPT with or without me.  I decided to check into it again.  I found that the criteria was more specific than it originally had been and the programs were much more organized.  I decided to pursue it after all.

I am so greatful that I did!  I have always gone to about 2 continuing ed seminars a year.  But now I feel much more current and updated.  I also can search the evidence myself when I need current info.  Patients are much more versed and research on the internet before coming in for treatments.  They want information.  They want to hear about studies.

I worked in an outpatient clinic for 13 years.  Direct access is very beneficial.  We had many patients who had previously come for treatment, hurt themselves again, come to us first, and then we would send them to their doctor.  With direct access they did not need to wait to see their MD first.  They could come to us first and THEN we needed to make sure we got the referral.  However, we can at least begin the treatment.  We had a good rapport with many of the doctors.  We knew who would just send us the referral after seeing the eval and who wanted to see the patient first.    This certainly was more beneficial to the patients because they did not have to wait to to get treatment and have their pain and/or impairment worsen.

I picked up some per diem hours in an SNF to help fund my DPT education so as not to disrupt the household finances.  I have enjoyed this so much that I have left the outpatient clinic and am strictly doing per diem work in the SNF.  The other benefit is the schedule fits with where my children are at right now.  That is the beauty of this profession.  I have changed my hours many times over the years to balance work and family.  I make working 20 hours per week what many people make working 40!  I always know that if I was really stuck and needed more money, the hours are out there.  As I've grown older, I've also realized that people have money for what they want to have money for.  Many people who claim they don't have enough money want too much.  Don't get me wrong.  I know there are many people living well below poverty.  I'm not talking about them.  I'm talking about the general middle class income people who are always complaining about making ends meet.

I am in this profession because I love it!  Even after almost 15 years I can say that!  I've often said that if I could do it all over again, I wouldn't change a thing!  Our advancement in this profession is not in an upward ladder, but in self growth to try to provide the best care for our patients that we can!

Kim, RI

Kim, physical therapist January 15, 2008 5:18 PM
Burrillville RI

Having graduated in the '80's, I remember the move towards the Masters degree. This was something pushed by the APTA (I don't think that I was a member at the time, because the direction it was heading us was not something palatable). I don't remember this being something that the "rank and file" decided upon; it was supposed to make us more "professional" and "acceptable" as professionals with the research generated justifying what we do.

The move towards the doctorate degree strikes me as deja vu.

At the end of the day, the health care providers that we work with will still have the same concept of what we do, and the same expectations. They will only believe us to be professional and deserving of respect by our own individual actions.

As an afterthought: I've heard from DPT grads. that they won't work Acute care, SNF, Rehab or long-term care because of the risk of injury and they need to pay off their large student loans. It only leaves us older PT's to risk our bodies for the sake of patient care. (I know that not every DPT may think this way).

Douglas Macleod, PT - RPT January 3, 2008 8:40 PM
Northridge CA

I'm really confused as to why you're cautioning me against calling myself "doctor" - that's something I would never do and hasn't been alluded to whatsoever in this conversation or blog. That's ridiculous, we aren't physicians. There's a nursing doctorate but obviously it's not okay for them to walk around the hospital calling themselves Dr. Nurse. Physicians should only call themselves doctors - not chiropractors, not pharmacists, not therapists. That issue isn't what we're talking about, and neither is the DPT, really. I've said nothing about agreeing with it or not, I simply said it's absurd to think people go to school for their doctorates without researching salary statistics first. I also said there's no comparing ultrasound techs to physical therapists in terms of anything other than salary - ultrasound techs are nonprofessionals. If you're choosing a career strictly on money and can't swing college, it's a great option. If you value having a college degree, it's not. Those are the only things I've mentioned on this blog so far - nothing about agreeing or disagreeing with the DPT. It's no longer a choice - if you want to be a PT in my area of the country, you get the DPT. There are no more masters programs.

Allison Smith November 28, 2007 11:20 PM

I went into the field because I love it. I still do. I never said anything about not liking the profession I chose. Please chose your words properly. The entire argument is the DPT. I took the extra 3 classes because I knew they would be utter jokes, i.e., medical ethics, medical imaging, and a research course on pediatrics, and because there was no application for my class, no fee, no nothing. It was way too east not too. If I was already out practicing and had to go back, like I stated in other comments, I would not go for the DPT.

You are still missing the bigger scope of impact the DPT has on students currently going for it or considering going for it. Like Major Bob Feldman stated in his article, "I was opposed to the profession going to an entry-level doctorate and will continue to oppose it, especially as I continue to witness the incredible amount of debt these extra years of schooling have placed on the shoulders of many students. I have also seen some people who would have made excellent PTs shy away from the profession because of the time and money involved. So, until I see proof that the DPT is able to practice significantly better than those with the MPT or BSPT, and that it's worth the extra time and money, I will not support referring to graduates who have a DPT as "doctors.""

Let me ask you a few questions...

1. Will you call yourself Doctor Smith when you are done with school? If so, be prepared to get laughed if you work in a nursing home or acute care facility. Nurses will not refer to you as Doctor Smith. It will not happen.

2. Do you honestly believe those with DPTs are better clinicians than those with MSPTs or MPTs?

Just remember this Allison, be careful who you refer yourself as a "Doctor" to. Many don't appreciate it.

Good luck to you!

John November 28, 2007 7:53 PM

I find it hard to believe students would go into a doctorate program having done no research on the field, with the idea that they will come out making 100k+. Sorry, but that's ridiculous. Many observation hours are required, extensive knowledge of the field is needed for your interview, etc. I can't see ANYONE shelling out that kind of money for an education without having the slightest clue about PT salaries. I'm not buying that.

I have also heard that salaries in NY for healthcare professionals are some of the lowest in the nation - NYC may be the exception to this, though, but you said you work in New Jersey anyway. From the employers I have spoken with in my area, I am told that start salaries are around 58k where I live, and many students take jobs at nursing homes for 1-2 hrs a few days a week also, at around $100 an eval. The traveling companies I have spoken with have quoted wages up to $45/hr. There is money to be made depending on how much you want to work, as with anything. Physicians make so much because they spend 70hrs a week at the hospital during residency and even after. The PAs I know are also on call a lot of the time, and work around 50-55 hrs a week. I personally don't want that. But anyway, I'm not hear to argue of salaries. If you're not happy with what you're making, why would you have chosen PT as a profession? I quick trip to salary.com will clear up any misconceptions. And if you yourself are so disheartened with the whole situation, why exactly did you go into physical therapy - and why did you pay for the DPT if you are so against it, I must ask? No one had a gun to your head - this is a free country, and we are all free to pursue the career of our choice. If you would prefer being an ultrasound tech, why didn't you do it?

Allison Smith November 28, 2007 5:50 PM

I couldn't have said it better myself Jeanne. I do think it is exactly what the APTA created the DPT for and why schools are so easy to go along with it. The bottom line for the academic institutions is the almighty dollar.

Why has the PTA been forgotten in all of this? Without them we would not be able to practice as efficiently as we do. They deserve the same amount of respect as we. Again, the APTA is missing the boat. I actually think they jumped straight into the water in my opinion!

Allison, I am not sure where you are hearing that you will come out with your DPT and make 70K after 3 years. Maybe your friends are inflating their salaries a bit much? I live in the NYC metro area where salaries are typically the highest or 2nd highest in the country. New grads with DPTs are not making near 70K unless they are working 60-70 hours per week plus weekends. I do not mean to discourage you, but place yourself as a single person in the northeast at 23 years of age. Most 23-26+ year olds are not married up here. To be able to afford to live on one's own, even with roommates, and pay educational debt is not possible if one was to go for their DPT. You need to see the broader picture outside of your situation, try to see how going for the DPT affects students as a whole. I truly believe MANY, if not ALL, undergraduate students applying to all the 6-7 year DPT programs believe they will come out making 100K+ with their DPT. It just isn't going to happen. Many of them are just happy to have been accepted into a program so they go unknowingly. Hopefully that makes more sense. Did you read Major Feldman's article I referenced?

ps...Where I went to school the majority of my professors didn't and still don't think the DPT is a good idea, yet the APTA pushes it. Their words, not mine. Get to know your professors and they will tell you the same.

John , Pediatrics - DPT November 28, 2007 1:52 PM
NJ

I came from a non-traditional background. Prior to becoming a PT, I graduated with a business degree and obtained considerable work experience in both the business and government settings.  

When interviewing for the PT profession, I expressed my concerns for our industry. Basically, PT tries to legislate it's market share by lobbying our state governments This is very different that most other professions. For instance, in the automotive industry, if you can't compete, you lose market share to other companies. In the end, it won't be who legislates best, but who (which profession) meets the needs of our patients best.

Now we have the impression that getting a higher level of education will gain more "respect" and autonomy from other professions. Frankly I have never considered respect a problem with any physicians.  Respect is what we make of it. Those who hope to gain a "better image" with a higher degree... well hopefully you understand my thoughts on this by now.

As far as autonomy; frankly, if you want to run the risk of 24-7 responsibility, carry a weekend pager, pay malpractice premiums through the roof and give up your family life, then feel free to move forward. One of the real benefits of PT has been the MD umbrella we operate under. Most MDs will quickly agree with our assessment and direction since they respect our opinions. We have a tremendous amount of flexibility as it is, are paid quite well and can still take time to spend with our families and friends.  

Getting more education and credentials "may" get a little more respect... maybe...  However, pay schedules are driven by market demands and potential reimbursements for an organization. Our MPTs are paid the same as PTs in many settings. Stating that everyone has to be a MPT or DPT is a little unrealistic at this point.

I respect the DPT. Anyone wishing to pursue this level of education is to be commended. However, "smarter or better educated students" do not necessarily make better clinicians. To drive that point home, look at how many "A" students are working for "C" students in industry. More education does not ensure quality working relationships with our patients.

Jim, Phyiscal Therapist November 27, 2007 6:11 PM
Akron OH

John,

I was in no way defensive in my response about ultrasound techs, just simply stating that I would hate to invest $15,000 into a program (and 2 years of college prereqs beforehand) to not even have a college degree.. and to be a technician for the rest of my life. I do place great value in my own life on being a professional. I see myself being bored to tears scanning bellies and chests all day long for the rest of my life, honestly - it simply doesn't appeal to me. Everyone I've known personally who went that route were the ones who "couldn't swing college". It was a great option for them, because they were barely able to pass basic pre-reqs.. college chemistries and physics were a definite "no". The ultrasound programs care very little (to not at all) about GPA - it's one of those things where you pay your money and you're in. I'm not being defensive, I just want more out of my education and career than that. I want to be a college graduate. When I said "they don't make a difference", I'm simply stating facts... nobody is going to remember the tech that scanned their belly and gave the image to the MD who let them know the sex of their baby. They don't help people, they don't make people better.. they scan. They are technicians. Hell, master plumbers and welders make great money too... at the end of the day, it's not all about the money.. but don't think I'm not realistic. I have friends who graduated from the DPT program within the last 3 years and are bringing home around 70k a year.. not too shabby in my opinion. I don't need to be a millionaire, I care more about lifestyle. If I didn't, I would've gone to med school.. had the 4.0 and everything to do it. I don't want to be a slave to the beeper, I don't want to be a pharmacist mixing meds all day, and the PA program at my school didn't have an undergraduate entry option, so PT it is. With my husband's comparable salary, I don't see bringing home 120k+ a year at 23 years old as insufficient. Maybe I'm naive.

Al November 27, 2007 5:39 PM

I am an "older PT" and I do enjoy my work. I benefited from the "golden age of PT" and I have seen the "PT glut" too.  It is very realistic for young PT's to expect more pay for more education, but the system does not support that and most likely never will. The reason to go into PT is because you want to be a PT! Know what you're getting into.. including the salaries.  I've told more than 1 PT volunteer to research the field and if you do and your heart is in it... go for it!  I'm not "sold" on the DPT as the only PT degree to be offered. We do need research, so have those PT's who choose that route ,do that. Perhaps the Vision of 2020 was short sighted on many of these issues brought up in this forum. We should be able to co-exist as PT's, MPT's and PTA's without all this confusion and offer our patients effective care without having all of us be DPT'S. I do agree that some of this drive for the DPT has become a financial focus for the schools and a status symbol for the APTA. If PT's are all to be DPT's, is the next step to have PTA's attend at least another year or two of school?  

BPTA anyone?

Jeanne, pediatrics - Senior PT, school based November 27, 2007 5:12 PM
TN

Here is a link to a great article written by Major Bob Feldman who writes for ADVANCE.

http://physical-therapy.advanceweb.com/Editorial/Search/AViewer.aspx?AN=PT_07feb12_ptp80.html&AD=02-12-2007

John

John , pediatrics - DPT November 27, 2007 2:02 AM
NJ

Dear Alison,

I am not sure what your professors are telling you, but the salaries of Directors of Rehab are not incredibly higher than those of PTs on staff. Autonomous practice is highly over-rated. Physicians will always be the key holders to the golden land, except in pediatrics. Remember you are not going to get reimbursed for services unless a physician has written that almighty prescription which has made it into the hands of the insurance companies/Medicare, etc. We can lobby all we want. The fact is that in the real world patients do not walk into physical therapy settings and ask to be evaluated. They go to their physician who refers them for PT. The caps will never go away. I notice you use the word 'Hopefully.' I would love to keep in touch with you to see what your take is 5 years after you begin to practice.

You talk about making a difference in someone's life. Great! I agree. Why do you think we all go into PT? But once again, at the end of the day, you need to be able to survive and pay your bills, and that includes the high amount of educational debt incurred by pushing for the DPT.

As for your friends who who took the US Tech route. You can't say, just because they are technicians, that they don't make a difference in someone else's life. I will chalk that up to you getting defensive as I am 100% positive you are a DPT student who is amassing a high load of debt.  Your friends who chose their route may have made well over $300,000 take home pay if they were living in NJ by the time you received your first paycheck. That doesn't seem all too dumb of a move to me.

H.R. 3363: Medicare Patient Access to Physical Therapists Act of 2001 (http://www.govtrack.us/congress/bill.xpd?bill=h107-3363) was first introduced to 107th Congress. This bill is now H.R. 1552: Medicare Patient Access to Physical Therapists Act of 2007 (http://www.govtrack.us/congress/bill.xpd?bill=h110-1552). There is also S. 932: Medicare Patient Access to Physical Therapists Act of 2007 (http://www.govtrack.us/congress/bill.xpd?bill=s110-932).

H.R: 3363/1552 has been going to the House Ways and Means, the House Ways and Means Subcommittee on Health, Senate Finance, etc etc etc since 2001 with NO VOTES YET. Do any of your professors keep you up to date with status of "true" direct access? Remember this as well, the AMA has a ton of lobbying power! Most likely one reason there has yet to be a single vote since the original H.R. 3363. Physicians will lost office visits co-pays and initial visit reimbursement, etc etc...They have much to lose.

I do think PTs have all the knowledge to be access points into the healthcare system. Unfortunately, the APTA is very weak union. best of luck!

John, pediatrics November 26, 2007 11:47 PM
NJ

I too have friends that have gone the ultrasound tech route and had a fleeting moment of jealousy that they were in ten month programs that started them off at basically the same salary as a graduating PT with 6 years of schooling under their belt. However, at the end of the day, I'm excited about being a professional. Yes, a PROFESSIONAL. Ultrasound techs are just that - technicians. They rub jelly on pregnant stomachs and hairy chests all day long, with no autonomy whatsoever, they don't help people, they don't make decisions, and they have little room to advance. I will be happier knowing I made a difference in someone's life; made their life a little easier. I will also be happy knowing I have opportunities for advancement in terms of management positions, etc. Hopefully, though, adjustments will be made within the next 10 years or so that puts a cap on these over-inflated salaries of nonprofessionals, just as it has happened to all professions after they've been around long enough for people to realize what's going on. This has even happened to PT - ever remember hearing your professors speak about the "golden age" of PT? Yes, those days are gone.

Allison, Student November 26, 2007 9:18 PM
Mobile AL

At this point in my career, having been out of school 5 years, Vision 2020, means very little to me, as does the APTA. Most practicing PTs and PTAs are not members. I started out in a MSPT program at a state school, which transitioned my class into the DPT. They made it so easy I had to take advantage of it. If I have to do it all over again, to be quite honest, I would choose another field. Whether a new graduate has a MPT, MSPT, or DPT makes ZERO difference. Your starting salaries will all be near the same, regardless of what area you practice in. Experience is what matters the most.

I would have a hard time choosing PT again, especially the way some of the DPT programs are designed at private schools. I will use Seton Hall University as an example.  Undergraduate tuition is $28,000. Add in room and board for a total of $37,860. That would make the first 4 years cost a total of $151,440. Here in NJ undergraduate students may be eligible for specific grants which can lower costs near $8,500. There are also other grants. There are still 3 years of graduate study left for the DPT at a cost of $826/credit. How does the APTA justify the cost of the DPT relative to salary of a PT?

Take a look at what Salary.com lists as the average salary for the following occupations in the U.S. in 2006:

Physical Therapist     59,401

Pharmacist               94,493

Physician Asst. (MS)  72,145 - 76,053

Ultrasound Tech       56,138

Notice the last occupation makes, on average, only a little less than 3k less than PTs do, yet the APTA continues to push the DPT. One can go to school to become an ultrasound tech in as little as 1 year! YES 1 YEAR! How disheartening is that to a PT?! (http://www.diversityalliedhealth.com/features/02-07-06a.html)

I am sure this will get replies from older PTs stating how, "I am sure you went into PT to help people." and "You should never do something for the money." To them, I say one word, REALITY. I have to work 70 hours a week in NJ to pay my student loans, afford my rent, of which I share, to pay my bills, eat, etc. If PTs salaries continue the way they do the profession will not last. I have the DPT, but it really does mean nothing. No other health care provider respects it. Ask other DPTs who are in touch with reality.

One thing the APTA should actually be working on, whether people want to hear it or not, is limiting the number of international PTs coming over on work visas. Many of you may think it's not right of me, but it is definitely creating a "trickle down" effect out. It is begins in the nursing homes.  It is simple economics, something the APTA has no clue about it seems.  Many of the nursing home rehab positions for PT are filled by foreign educated applicants with BACHELORS DEGREES working in the US on work visas. Companies can pay said foreign educated applicants less, provide a work visa, and have them for 2 years at their facility. This takes away positions from US educated PTs who now apply for other jobs making these jobs much less competitive as their are now MORE PTs in the job applicant pool. Yes...there are more than enough jobs for every PT in the US, but the salaries are not high enough to sustain one's living expenses if they must pay their way through graduate school.

Dear APTA...please help our students now!

John , pediatrics - DPT November 26, 2007 7:18 PM
NJ

I have been practicing for 30 years and am still excited about our profession.  I love Physical Therapy and can't imagine doing anything else. When I first heard about Vision 2020, I had a lot of the same questions and concerns that Toni has.  I still don't agree with all of Vision 2020 but our leaders had foresight to at least start visioning where we are as a profession and where we need to go.  I agree that in order to get the respect of other professions and the consumer, PTs need to be evidenced-based...in order for that to happen, we need to have research behind us and someone has to do the research!  We need to be autonomous in that WE make the decision as to what is wrong with the patient and what needs to be done...not just take another's opinion that HUM (hot packs, ultrasound and massage) will suffice. We need critical thinkers...and I do think that a PhD will help in that regard with new therapists.

Other professions are actually beginning to come to the APTA and looking at our Vision 2020 so that they can develop their own vision.  We are the leaders of the pack here.  We may not all agree with all elements of the Vision...but it is just that...a VISION.  It gives us a place to start and it can always be revised if needed.

Over the years, I've seen periods of glut as far as PTs go (too many to all get jobs) and periods of famine.  Salaries are continuing to go up and you can always work more hours to earn more money.

I love my profession and hope that you will find that spark, too, Allison.  We help so many people and in so many ways.  We DO make a difference.

Joan, Geriatrics - PT, Infinity Rehab November 26, 2007 5:34 PM
Portland OR

From the standpoint of an undergrad student applying to a DPT program, it's pretty frustrating when all of your observation instructors and everything you read on the internet is negative towards Vision 2020. I had already chosen my major before the switch to the DPT was made at my school, and now I have to go through with it because this is what I want to do. With so many people drilling in my head that I'm investing too much money into a profession that will never pay me more, I've begun to feel less and less about myself and my career choice. I used to be excited about PT, now I feel nothing but worry.. hoping and praying that I don't regret my decision and end up eyeball deep in debt with no bright light at the end of the tunnel. I appreciate your thoughts and opinions and I enjoy reading this blog, but the up and coming PTs out there need some encouragement.

Allison Smith, Student November 26, 2007 4:17 PM
Mobile AL

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