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Toni Talks about PT Today

Paradox of Being a Doctor

Published November 9, 2010 1:14 PM by Toni Patt

This morning one of my patients surprised me. She noticed all the letters on my name badge and asked what each of them meant. Afterward she asked if I was sure I was a doctor. I don't act like one. Then she wanted to know the difference. Other than spending more time in school, I couldn't think of any.

That is the paradox the APTA has created. They keep emphasizing the DPT as the model of all things PT. A DPT has the knowledge to practice under direct access. A DPT has the skill to practice in an autonomous setting. The DPT fills in the knowledge gap. In other words, a DPT knows more. Meanwhile they consider grandfathering in all practicing PTs, with the effect of negating any differences. Everyone becomes a DPT.

This isn't a question of knowledge base or training. If you equate the two degrees under the same license, you have made the degrees equal. Let's look at it from the opposite perspective. My unit recently interviewed a PT who had a tDPT. During the interview, it quickly became obvious that although she had the degree she hadn't gotten much out of it. She knew the buzz words but wasn't fluent in them. The two PTs I work with know more than that.

Her advanced degree doesn't appear to have added much to her knowledge base. I doubt she's alone. I'm sure there are many more out there who have the degree but made no changes in how they practice. I don't see how that qualifies them to do more than the PTs I work with. The DPT is only as good as the person who earned it. Other than having more letters behind their names I don't see any differences.

A few months ago, I attended a CI credentialing course. The DPTs in the room were instructed to introduce ourselves to patients as doctors of physical therapy. Does anyone really think patients catch the difference? To most a doctor is a doctor. Most patients have trouble remembering names, much less keeping titles straight. My patients are usually so overwhelmed by everything that has happened, they stop listening at doctor and rarely remember my name until after two or three visits if they're cognitively intact. Telling them I'm a doctor of anything only adds to the confusion.

I'm a PT. I'll always be a PT no matter how many degrees or certifications I earn. A title isn't important. What's important is the knowledge I gained. I can make a good argument supporting the need for a tDPT in relation to Vision 2020 and evidence-based practice. That same knowledge isn't worth very much if it's forgotten as soon as the degree is completed. I still recommend PTs get one since the future is unpredictable and what might be acceptable to practice today may not be in 10 years. Meanwhile, I'm a PT who has a bunch of letters behind my name.


Toni, I've had a similar experience where I've met DPTs who are brilliant, cutting edger professionals who earn their "D" every day. I've also met DPTs and PhD PTs who languish and I wouldn't want to have perform PROM on someone for fear of them doing harm. The second lot are a big part of the reason I've chosen not to get a "D" myself. So what is the answer?

I want to continue to be able to practice. I am up on the recent research and journals in the area (older adults) that I work in and I stay current. I don't want to be awarded a "DPT" just because I've been working a long time. Regardless of whether I'm a good professional or a putz, I haven't earned it as you have.

Working in the UK has shown me that there are lots of other ways to tackle this issue. The constant evidence of relevant Continuous Professional Development that one must produce every 2 years in order to maintain licensure here is one good example. Let me tell you that it really keeps you on your toes and on top of current practice. In so doing, no DPT here in the UK, yet I can work autonomously and even prescribe medications (see my blog this week).

I think there are other creative ways out of the APTA's DPT box, but it would be really tough for the organization to change course now after committing to it.

Cheers, Dean

Dean Metz November 9, 2010 4:38 PM

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