Close Server: KOPWWW05 | Not logged in

Welcome to Health Care POV | sign in | join
Toni Talks about PT Today

What Is a Physical Therapist Extender?

Published October 9, 2012 1:47 PM by Toni Patt

Reading Jason Marketti's blog last week reminded me of a discussion we're having here in Texas. It's called RC-3 and is an amendment to the Texas Physical Therapy Practice Act. It proposes unlicensed individuals such as athletic trainers and massage therapists be used as PT extenders. These extenders are to provide care as directed by the physical therapist.

That is pretty vague. Taken at face value, it implies non-licensed individuals be allowed to provide skill care under the direction of a physical therapist. Texas PTAs are viewing this as a threat to their profession and livelihood. Why would anyone pay a PTA salary when a much cheaper unlicensed individual could provide the same care?

Not only is such a thing scary, it's wrong in numerous ways. Equating the care provided by a PTA with that provided by an ATC or RMT completely discounts the education and training that goes into becoming a PTA. It assumes those individuals have the same clinical judgment as a PTA. I don't know about anyone else, but no way is a therapy extender touching one of my stroke patients.

A general consensus of PTAs attributes the measure to the OP ortho faction of our profession. Since RC-3 became general knowledge, I've heard horror stories of clinics where one or two PTs oversee as many as 19 patients at a time. I've also heard of clinics where double- and triple-booking is the norm. Having therapy extenders would increase the amount of one-on-one time between patients and staff without the expense of hiring more PTs.

It's a given facilities will jump at anything to cut costs. Maybe, just maybe, you might pull it off in an OP setting. What about a hospital? Hospital administrators aren't stupid. They're going to jump on the bandwagon of saving money. So will SNFs, LTACs and everyone else. The last thing a seriously ill patient needs is a therapy extender coming to exercise with them.

I'm not discounting the knowledge and skill of ATCs and RMTs. They're good at what they do. They studied to do what they do. But what they do isn't physical therapy. Saying those professions are capable of providing physical therapy care without additional and significant training is ridiculous.


I totally disagree with you on all levels... Someone that has been through an Athletic Training Program as well as double majoring in Exercise Science; I feel I am fully capable of being a physcial therapy extender. I keep up with all the latest research studies and quality information out there as well.

Chad October 18, 2012 9:49 AM

Thanks for the added information Sean.

Toni October 11, 2012 6:53 PM

The extenders relate to anyone so long as the PT is in charge of the patient.  So effectively you could bill for gait, therex, and neuro by having a CNA do the activity with the patient.  Cost savings is huge.  It becomes an ethical question for PT's on whether they feel a CNA is capable to treat patients versus a PTA.

In OP this has been going on for a long time.  People assume they are being seen by a skilled professional and in reality they are being treated by a rehab aide/tech.  The same in a SNF, a PT could delegate treatment to the aide(s) to see all the Medicare part A patients and bill accordingly.

It is hard to speculate on why the APTA and state boards came up with the "extender" rule since they continue to tell the PTA's they have an important role in health care.  

Jason Marketti October 11, 2012 1:39 PM

Toni, to be clear:  RC3-11 was a motion, brought by the Private Practice Section, to the 2011 APTA House of Delegates (HoD).  After a task force was assigned to work on the motion, another motion (RC2-12) came to the 2012 HoD, and passed with a proviso, meaning it will not take affect for at least a year.  A brief summary is available here:   The motion identifies a new position on extenders by the APTA, who previously only endorsed the use of PTAs as extenders.  The position statement reads “Physical therapy is provided by, or under the direction and supervision of, a physical therapist (PT). Evaluation remains the complete responsibility of the PT.”   As you stated, the position is quite vague.  In effect the APTA, if they adopt this position, will become silent on the use of physical therapy extenders.  This statement does not, by itself, change any state practice acts.  But as you mention, it may be used as evidence for individual states to amend their practice acts with this language.

AS a PTA I feel that RC3-11 and the intent behind it is a way to skirt the issues.  One of these issues is educational reform for PTAs.  There are PT’s that feel the PTA does not have the proper educational base to be effective in the clinic. While I do not feel this is a true or fair statement; if PTA’s are lacking the skill set that is needed in the clinic, then we, as a profession and a professional association, have the responsibility to improve that skill set through educational reform.  This was proposed at the House of Delegates this year with RC 20-12, but several Delegates spoke out against the need for change for a variety of reasons.  Despite this the message is clear; there are PT’s that do not feel that the PTA is a member of the clinical team.

This issue will not be resolved by bringing in others to the work force. If a PTA cannot be respected, or allowed to grow in their educational preparation (as RC20-12 proposed), how will adding other providers improve patient care?  Will we expand to another set of extenders when the ATC’s and RMT’s are not meeting the needs?  PTAs want to be team members, working together with the PT to provide excellent clinical care for our patients, facilitating increased access to physical therapist practice.  When will we realize we are stronger together than divided?

Sean Bagbey, MHA, PTA, October 10, 2012 5:23 PM

leave a comment

To prevent comment spam, please type the code you see below into the code field before submitting your comment. If you cannot read the numbers in the image, reload the page to generate a new one.

Enter the security code below:


About this Blog

Keep Me Updated