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Toni Talks about PT Today


Published September 22, 2009 4:56 PM by Toni Patt

Last week I had the pleasure of hearing Rebecca Craik, PT, PhD speak. She gave her perspective on the past and future of physical therapy.  As she is the editor of the Physical Therapy Journal she is in a position to talk realistically about what's ahead for us.  I can sum her 90 minute lecture into two sentences.  The profession of Physical Therapy is making good strides in preparation for Vision 2020.  The individual therapists who make up the profession are not.

That sounds harsh.  A few years ago our profession made decisions about where it wanted to be positioned by the year 2020.  Based on those decisions action plans, such as the DPT, evidence based practice and specializations were put into place.  Increased emphasis was placed on direct access.  Whether these goals are reached in time is yet to be seen.  But, as Dr. Craik pointed out, the changes were made.

According to Dr. Craik this is not true of individual clinicians.  We have a lot to do to prepare.  That includes being flexible and embracing the changes.  Consider that less than 10% of practicing therapists are DPTs.  The number of certified specialists is less than 10, 000 nationwide.  Admittedly there has been resistance to changing, particularly concerning the DPT.  This resistance is probably a big piece of why clinicians aren't ready. 

The reality is the profession has changed.  Dr. Craik pointed out that practice has become more like research.  She also pointed out the lack of research.  Currently there is a disconnect between research and clinical practice.  What we need, said Dr. Craik, are more clinical oriented researchers.  We the clinical know what needs to be researched.  Who better to do it? Not all research has to be theoretically based.  We also need research that support our treatments and defines the best practice for each. 

It's easy to get caught up in everyday life.  It takes time and money to get education or prepare for certification.  My department is probably typical.  No one else is interested in getting a DPT.  No one else is willing to do the work to get a certification.  Generalize that to the entire population of PTs and part of the problem is evident.  Advanced degrees and certifications aren't reasonably for many people. 

What about evidence based medicine?  Only two of us in my department can actually explain it.  A third, a new grad, knows what it is.  The rest have no interest.  Evidence based practice isn't difficult to understand.  It could be learned in a CEU format either in person or online. I don't think I've seen even one course offered on the topic, only included with another topic.  Including evidence in our education is important. But it doesn't do  any good if no in the class understands the significance of the evidence.  One of my future goals is to do a class for the facility.  And I will, if I ever get the time to actually do it.

It's time for clinicians to wake up and get moving.  The PT profession is moving forward.  Either we adapt, make changes and go along for the ride.  Or, we get left behind.  The ripples of change are beginning to develop.  It's easy to continue with business as usual.  When those ripples become waves some of us will be lost in the undertow. 

posted by Toni Patt


For those of us serving more remote,rural areas of the country, all continuing education is done on our time, on our dime. Speaking for myself, I need to make every dollar count. I do the best that I can and so do my dedicated staff and co-workers. Having 1-2 course paid for?... not in our area. Broaden your view. How can "LAZY" people afford 6 or so years of college education?!  The field of PT should be both at a master's and at a doctorate level. The vision of 2020 is short-sighted!

Jeanne, PT - Senior November 17, 2009 7:51 PM

Wow Toni, Great commentary! I struggled with the decision on whether or not to get my DPT. In the end I chose not to go that route.   My reasons are numerous and I am going a different route altogether, an MPH, possibly PhD in public health. So I don't fit the paradigm of "lazy" practitioner exactly.

Working in New York, time off is very generous allowing more ability to attend courses, gain certifications, and grow in one's career. When I worked in Florida, I got just over a week off in a year and the employer didn't reimburse for continuing education nor provide additional time off for it. Growing as a professional there was nearly impossible while still maintaining a life and paying one's bills.

I'm thinking that if we need more research though, we need more PhD PTs. The DPT supports more autonomous clinical practice, but is that really sufficient for serious research? Based on the DPTs that I know, I would say not.

Becoming a PT can send one in a variety of directions with their career. Perhaps a DPT, perhaps a PhD or perhaps even in another direction like myself. I agree though, that to rest on one's BSPT or MPT for decades doesn't do anything much for the profession as a whole.

Dean Metz September 23, 2009 10:07 AM
Newcastle Upon Tyne

I don't think the comments are too harsh...I think they are right on. I'll make the harsher comments. As a profession, Physical Therapy is really good for attracting intelligent, hardworking individuals, but it also attracts LAZY people who were willing to work hard for their entry level degree, but have no motivation to do more afterwards.  A good friend of mine exclaims "I can't understand why you want to keep going back to school and doing certifications...I have absolutely NO desire to do it...even if it were paid for." Sadly, I think her feeling is common.

However, the other side of the coin is the finance. It's rare to find a clinic that will pay more than 1-2 weekend courses a year for their employees.  Therefore, rather than enter a structured, organized, degree-oriented program, clinicians are finding it more financially feasible to attend the "University of Holiday Inn."

What's even rarer is to find a clinician who is willing to pay out of THEIR own pocket to pursue further education. Part of the reason is lack of financial incentive. It's pretty rare to find a clinic who is willing to pay more for a therapist with advanced certifications. Rather, many clinics find it more economically feasible  to hire a "cheap" mediocre therapist.  Therefore, we become a profession of complacency.  

When pay for performance becomes more regularly practiced, suddenly we'll see a shift in educational trends...that's my prediction anyway.  

Christie , Physical Therapist September 23, 2009 9:04 AM

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