Are We Ready for Direct Access?
This semester I'm taking a class addressing differential diagnoses. Its purpose is to prepare me to screen patients for medical problems prior to initiating therapy. Each chapter covers a different system and reviews the signs and symptoms of medical conditions that might mimic physical therapy diagnoses. The purpose of the class is to prepare me to practice in a direct access environment. Though the class has barely begun, it's been an eye-opening experience.
Before starting this class I would have told you I know this stuff. I would have said since I work so much in acute care, I'll recognize the difference. I would have been wrong. We've barely covered the patient interview, and I've found myself inadequate. Who knew to ask such questions? Working in acute care has spoiled me. I always have a current H&P to work with. The medical conditions, PMHx, home meds, etc. are written down for me. Until recently I didn't realize what was involved in getting that information. Any PT will agree that getting useful information from patients is difficult at times. It would be next to impossible to get this kind of information if you didn't know the questions to ask and what to ask in follow-up.
Even though there is a lot of information I don't think it will be difficult to learn. As I get into the readings I'm seeing some logic in the process. By the time I finish I should have no problem knowing how to obtain the information and what to do with it. I have an excuse for my lack of knowledge. This wasn't taught when I went to school back in the day. I've yet to see a CE course covering the material. Until this class I hadn't had an opportunity to learn. DPTs are exposed to this during the education process. The patient interview process won't be a problem for them. What about everyone else?
My understanding is that as we move closer to everyone being a DPT, those of us who aren't will be grandfathered along enabling us to keep practicing. I don't think additional education of that nature will be required. If I'm correct, therapists who aren't DPTs will be able to practice as one. In a profession that is pushing for direct access across the board that scares me. It's all fine and good to say existing PTs can continue to practice. The problem I see is allowing those same therapists to work in a direct access setting without requiring them to have the same education. I'm not talking about therapeutic skill. I'm talking about knowledge and liability.
My understanding is that no restrictions will be placed on the grandfathered therapists. I speak from experience when I say in this area there will be a knowledge gap. My textbook is filled with case studies illustrating instances when a PT did and didn't pick up on an alternative diagnosis. I have no reference point to say how rare such instances are. All it would take is one major mistake and someone's career would be over. I wonder if the APTA has thought of this.
I don't want to get into the "everyone needs to be a DPT" debate. I now think someone practicing in a direct access setting should be a DPT. Maybe the PT world is debating the wrong subject. I know many PTs with strong opinions about the DPT, but no one who has any opinion about direct access. I can make a strong argument either way using exactly the same information. Among my friends the general consensus is it won't happen anytime soon because insurances and physicians will resist. That may be true. But if it were to happen in 10 years the majority of us would still be practicing and no more prepared than we are now. There are a lot of therapists in my age group this will affect. Are we going to be prohibited from practicing in those settings because we lack the knowledge deemed necessary to do so? If there is a sudden rush for transitional DPTs, the schools will be overwhelmed. The process takes between 1 to 3 years. It might be a solution for some but it won't be timely.
I have no idea what the answer to this might be. Maybe I'm creating a problem where none exists. I might be reading more into this than is actually there. I'm basing my comments on myself and I went to school a long time ago. The curriculum has changed so much it might not be a problem for more recent graduates. We live in a sue-happy society. I can easily imagine a PT being sued over less. As soon as I started reading the first chapter I started thinking about this.