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Toni Talks about PT Today

Direct Access and the DPT

Published January 25, 2011 11:22 AM by Toni Patt

Today I ate lunch with someone I hadn't seen in a while. He wanted to tell me about the new facility where he is working. Someone there recently earned a DPT. He said the rest of the staff was now fawning over the new DPT. He asked me what my facility did for me when I graduated and whether I was enjoying my new status.

The APTA would be thrilled with that conversation. Individuals both within and outside of the PT world recognized the DPT as something important. Supporting direct access can't be far behind. It looks like progress is being made on both fronts. Compared to my facility, there is definite progress. Where I work I'm the only DPT. It brings me no recognition, respect or added responsibility. Direct access and the DPT have something in common. The majority of practicing therapists don't care about them.

The DPT remains an enigma. I know there are other DPTs in Houston. I don't know how they are treated within different departments. The APTA wants the DPT to be the end-all of PT but fails to take into consideration that respect and value for the DPT come from the rest of the PT population. If other PTs don't see value in it, neither will other disciplines including physicians. The same applies to direct access.

In less than a month, the TPTA is sponsoring a legislative day. The purpose is to show legislators grassroots support for a direct-access bill. The TPTA is asking therapists and students to head to Austin to meet with various legislators, committees and whatnot for the districts where they live. I find it ironic that neither of the two biggest proponents of direct access have DPTs. I wonder how they defend direct access without explaining how important the DPT is to that cause.

It's even more ironic that most of the targeted population of PTs and PTAs don't really care about either one. They might not even benefit depending on how the bill is written. There are many more PTs and MSPTs than DPTs in Texas. Passing anything that specifically states care must be provided by a DPT shoots a large hole in the cause. The ultimate irony would be passing direct access for DPTs only, so I could practice under it but others could not. Stranger things have happened.

Those supporting direct access may have an eye-opening experience as the lack of grassroots support becomes more obvious. As of last week, 50 people from the southeast district had registered to add the legislative day. That isn't a lot of people when you consider how large Houston is. It's much easier to achieve something like the DPT when grassroots support isn't required.

I don't remember getting e-mails encouraging me to pressure local schools to change to a DPT. I don't think anyone would have done that. Direct access is different. In order to get it, lawmakers must see that it matters to the profession. That means thousands of people, not hundreds, must show support and that support must be ongoing. I don't see it. It also means real money - hundreds of thousands of dollars. Unless the APTA is willing to help each state, I don't see that happening either.


In this world of Evidence Based Practice, what about evidence based business? Where is the evidence that having a DPT is suddenly going to make the rest of the world sit up and take notice, that salaries and respect will increase, or that it will further the cause of direct access? There is none. Lawmakers, MDs, and Insurance companies don't care about the DPT. PhD PTs who provide clinical research and publish on it are more likely to sway the minds of those currently holding the power. I have direct access in the UK and in New York with my bachelors degree.

In actuality, this is a lark by the APTA.

Let me make clear that having a DPT is a worthwhile aspiration and that theoretically I agree, the more educated and informed a professional is, the likelihood of them being a better clinician should increase. The new grads should indeed be better skilled than I was in 1992. But that doesn't mean they are better skilled than I am now.

Just wondering, do you have any patients going to the legislative day? Clinicians are fine, but can hardly be called unbiased. Patient stories may more likely touch the heart, be regarded as unbiased, and have lawmakers see constituents rather than special interest groups at their door. It is a technique that has worked in the UK.

Good luck with it and if you go, please post about the results.

Dean Metz January 26, 2011 1:10 PM

The most skilled PT I have ever worked with wasn't even originally a PT.  She was first a physiotherapist.  After her education she went on to take courses in her area of interest.  She didn't take weekend courses in vacation destinations.  She took hard core courses that required her to study at home for months and to attend practicums.  We worked together with an orthopedic surgeon.  Because of her expertise in manual therapy, it was not unusual for her to diagnose a concomitant dysfunction before the physician.  There was no direct access, but the physician respected her and acted on her information.  It wasn't because she had a DPT.  It was because she had expertise.

I've said it before and I haven't seen anything to change my mind.  Having the letters DPT after your name do not suddenly transform you into a PT god to be revered by others.  Those letters aren't going to give you respect.  But an entitlement attitude will result in others losing respect where they once held it.  

Other professions are not going to respect the DPT; they are going to respect the therapist who has expertise.  There are many ways to achieve that.

Janey Goude January 26, 2011 2:46 AM

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