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Toni Talks about PT Today

Whose Profession Is It?

Published March 13, 2015 3:40 PM by Toni Patt

Two weeks ago I attended a Texas Physical Therapy Association meeting. The speaker was Mike Conners, president of the TPTA. Last week I discussed my belief the APTA is too focused on issues, such as direct access, that do not affect the majority of PTs and PTAs. Mike made another point that needs to be considered.

We all know that physician's orders are required for PTs to treat patients. Mike pointed out that none of the other disciplines competing for the same patients have that restriction. Anyone can be seen by a massage therapist, an athletic trainer or a personal trainer without having to see a physician first. None of these have the education we have but all practice without restriction.

In Texas, as in other states, there is stiff resistance from the physicians to remove the physician referral from the equation. They have described PTs as skilled technicians who require the direction of a physician to know what to do. Obviously some of this is financially driven. If they control the therapy, they control the money.

In the hospital setting, I need the physician to tell me the patient is medically stable enough to begin mobilization. This isn't true in skilled nursing. The majority of those patients are stable. In the school setting, it is easy to recognize those children who require intervention.

This problem is larger than the conflict between therapists and physicians over referrals. It is a mindset problem. There is a large scale belief that physical therapists are incapable of treating patients without first having the approval of someone else. Part of that belief arises from lack of understanding about what physical therapists do.

Once again we circle back to the APTA. Educating the public about who we are and what we do falls under their umbrella. I don't see anything out there on a large scale. Individuals and small groups are doing this but we need a large-scale, national educational push over a long period of time.

For example, the elder former President Bush is known to have Parkinson's disease and other chronic health problems. Somewhere along the line he received physical therapy. An ex-president would be a wonderful spokesperson. What about Gabrielle Giffords, the ex-congresswoman who was shot? She received inpatient rehab at a facility in Houston. She could speak firsthand as to the difference therapy made in her life. Somebody missed the boat.

Here's the problem. Neither received therapy for orthopedic problems, which is what drives the push for direct access. I hope there were other reasons not to approach those people rather than tunnel vision as to what physical therapy is and does.

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I believe a few of these DPTs are doctor wanna bes, in that they want to be addressed as doctors. PTs with master degrees don't call themselves masters.

Roberta Abbott, PTA/COTA November 27, 2015 1:35 PM
Ocala FL

While I applaud my fellow PT's who've gone on to achieve their DPT and t-DPT status I must say I don't agree for a few reasons.  I have been a PT w/ a BS in PT for 30 yrs. now.  I have worked with both DPT's and t-DPT's.  For the most part they do the same work as I do.  Maybe they are making more than I am and I don't realize it but the level of duties has been the same in my view.

I don't think the AMA and physicians are ready to relinquish the control and ultimately money advantage of having PT's have direct access without a doctor's referral for treatment. I also like having someone medically cleared by a physician before they are referred to me.

I chose to further my career and am about to graduate with a MHA in healthcare administration but again I applaud my colleagues and am proud to be a PT.

Robert Young, Geriatrics - Staff Physical Therapist, UPENN LIFE March 24, 2015 4:02 PM
Philadelphia PA

What an excellent blog! We have direct access in Florida, but we are still encountering the same problem---an uneducated public!  In addition, most hospitals and out patient treatment centers still require the patients to have a physician's prescription despite the direct access.  I have said for years that the APTA and the FPTA are not branding our profession.  They continue to push empirical data, etc. but what difference does it make!  The decisions made by insurance companies and doctors are not based on this data at all.  It's the stone age here as far as I'm concerned.  

I have a private cash based practice.  I have been practicing for almost 29 years.  Three years ago, I gave up trying to be a part of the system.  I try to make a difference professionally everyday.  Most days, I feel like I am doing it totally alone!  It's time the PT profession woke up!

Debbie Leiter March 24, 2015 12:49 AM

I am a physical therapist AND a physician.  I chose to go back to medical school becuase I sharerd similar frustrations to those described in this blog.  I can not express how valuable and eye-opening medical school and residency have been.  My viewpoint on this issue has certainly changed now that I have the knowledge of BOTH a physician and a physical therapist.  I now know why it is important to first see a medical doctor in many cases.  Physical therapy, like so many other allied health professions, is pushing for 'doctorate level education.'  However, I do not think the profession, no matter how appealing the title of "Dr" may be, is ready for the responsibility, liability, or litigation that comes with the title.  I only wish I could express how important it is to respect other professions.  Doctors (physicians) should respect physical therapists (I certainly respect and value my PT education) and physical therapists (and other allied health professions) should respect a phsycians.  I will also be an advocate for physical therapy, BUT I now advocate with 7 years of medical training beyond that of my physical therapy education.  

Jerry, PT, Internal Medicine - PT, DO March 20, 2015 10:54 AM
Denver CO

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