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Toni Talks about PT Today

Let’s Revisit Autonomy

Published March 10, 2010 9:27 AM by Toni Patt
Autonomy: The quality of being self-governing; the right to self govern; self-directing freedom and especially independence, a self-governing state (Merrian-Webster)

Last weekend I graduated.  One of the requirements to graduate was participation in a meeting with the deans and faculty of the school to discuss the program and how it relates to the practice of physical therapy.  As you would expect, the discussion quickly became a rah-rah session for direct access. 

Most of the discussion I've heard surrounding direct access includes the word autonomy to describe how future PTs will practice. I take that to describe how we will practice when a physician referral is no longer needed.  PTs will be autonomous in that they don't need a gate keeper to screen patients.  If you look at the above definition, practicing without referral doesn't really fit under autonomy.  Autonomy infers the ability to practice without anyone else under our own rules that we enforce.  Is that really what we want?

No discipline is truly autonomous, although the MDs might argue otherwise.  Yes, they have their own governing body and don't require referrals to initiate treatment.  They don't practice in a vacuum which is what autonomy implies.  They are interdependent upon nursing, PT, OT, pharmacy, etc. to provide quality patient care.  Even though our current health care model is weighted toward physicians, it relies on multi-disciplinary teams to get the job done.  It's the dynamic systems theory on an epic scale.  Dynamic systems theory says things only go well when all components are functioning and equal.

PTs need to ask themselves a question.  Do we really mean we want to be autonomous? Or, do we mean we want the ability to practice without referral within the health care system?  There is a big difference between the two.  The first implies complete independence from everyone else. The second implies a larger scope of practice but with interdependence on other disciplines. Hmmm, which one do I want? 

We might have a better chance at success if we change our verbiage.  No one reacts well to being told they're not needed.   Tell someone that you want to work with them and increasing your scope of practice enable us to provide enhanced care and you get a different reaction.  Obviously the whole issue doesn't hinge on one word.  We have an all out turf battle.  Changing the tone of what we're asking for might lower some of the resistance.  PAs and NPs had similar problems. Somehow they managed to reach a compromise where they function with many of the same privileges.

I find myself wondering if anyone else has thought about this.  Was the use of the word autonomy taken out of context and snowballed?  Or was the word deliberately selected because of what it implies?  I've never heard this addressed. If we scale back the rhetoric but continue the push we might have more success.  At least law makers and physicians may be more willing to listen to us.


I am faced with a related problem where a Physiatrist wants to screen every order/consult before the DPTs.  Even if the requesting physician is clearly wanting a PT to see the patient.  I am looking for information to help us make a decision. Is it even legal for the Physiatrist to screen all orders/consults.  Do we sanction the screening by creating an enabling policy or do we allow the physicians direct access to the DPTs?

Any guidance would be appreciated.

Reuben Molloy, Ancillary Services - Vice President March 16, 2010 11:03 PM

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