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Toni Talks about PT Today

The DPT: How Did They Miss This?

Published October 21, 2015 12:36 PM by Toni Patt

The more I talk to therapists around the country, the more I get the impression very few of us think that requiring the DPT as the entry-level degree for the profession was a good idea. Taken apart from other issues, the DPT is a good thing. But as the required degree, it created a problem. The market did not and does not support it.

Several years ago when the rollout was being planned, the APTA told us it wouldn't matter. There would be plenty of jobs. The market would recognize the value of the degree and salaries would increase to match it. PTs were encouraged not only to get the DPT but also to sit for one of the specialty exams because specialists would be needed.

They were wrong on all three counts. The market, or rather reimbursement trends, is going in the opposite direction. For as long as I've been practicing, there have been cuts in reimbursement. In turn, decreased reimbursement drives down everything. I can't imagine anyone would think that trend will suddenly reverse.

There are four possible explanations. Those doing the planning didn't take this into consideration. Or they didn't think it would make a difference. Or their calculations were completely off. Or they didn't care. Any of those explanations implies lack of understanding of how the world operates.

The problems we face now aren't solely a result of the DPT, but it did significantly exacerbate them. In response, a new trend is developing. Experienced therapists are leaving the profession. The positions they leave are either filled by new grads or disappear. Experience matters, but not in a good way as no one wants to pay for it.

I, and many others, have figured this out. How did someone not think of this a few years ago?

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A DPT must be earned by doing the work or it means nothing.  Giving the title away is absolutely not appropriate and would result a diminished respect for our profession.

Grandfathering in is allowing all practicing Physical Therapy professionals to continue to practice with their current degrees and certifications not to just GIVE them the title of DPT.  

I have studied and attained my tDPT late in my career and found that I learned a great deal that was useful to my work.  The university credits were also used as my CEU's for the years I studied.

I am not aware of any states that are not grandfathering those currently practicing.  It is your choice whether or not you work toward the DPT and earn the title.

Claire Todd, PT - DPT, Home care November 27, 2015 4:10 PM
Mercer county NJ

A good read as usual with fascinating comments. As for the Assistant Professor from Nevada, if it was all about autonomous practice, then why has the UK had direct access for nearly 4 decades whilst graduates still have Bachelors Degrees? Membership in the CSP (the UK version of the APTA) is at 98% and is non-mandatory. No, I don't buy into that argument that it was necessary to get autonomy. If it was...then we need to face failed. I would like to believe that Dr Moffat had the best interest of the profession at heart when she ushered in the DPT program at NYU years back, unfortunately it was a gamble that had no evidence behind it that it would work. The APTA needs to stop with the false hope that it will all work out alright in the end and come up with some real solutions.

Dean Metz November 10, 2015 7:55 AM

This was a concern of mine more than 20 years ago when the push for DPT started.  Discussion with several physician friends, years ago, alerted me that PT's would never have the full autonomy our profession hoped for.  There would be too many obstacles from MD's and insurance companies.  I have met too many wonderful people who would have been great PT's but pursued other avenues when they realized the time and money it would cost them to get a DPT.  Staying with entry level education at the  Masters level would have been a better choice with an option to further pursue a DPT if one so desired.  I too have worked with excellent and dedicated clinicians who have BS, MS or DPT degrees. It is the individual person, their dedication and consistency in their own professsional growth, not their degree which has made them an excellent or poor clinician.  

Connie,  PT

Connie Dykhouse, PT November 6, 2015 5:42 PM
Central Coast CA

Hi Toni

was wondering from your post:

a new trend is developing. Experienced therapists are leaving the profession. The positions they leave are either filled by new grads or disappear. Experience matters, but not in a good way as no one wants to pay for it.

where are the the experienced therapist  gravitating to , when they leave their profession?



jo scar, PT November 5, 2015 5:33 PM

DPT is a scam perpetrated by aging academies who have not touched a patient or stepped foot in a clinic for decades. Protects their rosy rumps and give them job security to pass kooky and bureaucratic red tape rules. God help them if they run out of rules and objectives to mandate. I work with a couple of DPT's fresh out school with $110K in student debt still living at home with mommy and daddy. They are 25 years old working in a SNF. How dismal a future. It's sad to see these youngsters locked in crappy jobs way deep in debt. I tell aspiring students to stay away from PT. It is a dying dead end pseudo profession. I am so thankful to be retired. I work PRN now just for fun. Good luck all you DPT's. God knows you're gonna need it!

Robert, PT - CEO, LRH & ASSOCIATES October 29, 2015 9:50 PM
Chicago IL

Saw this coming a long time ago! A renowned NYU professor big with the APTA actually taught my class to forgo any further education in the PT realm, get excellent CE training, and look to business admin. or health admin. to put it all together! Well, I was the CI for 1 of her students a decade later... and so the story of the DPT goes! I would choose to be treated by an experienced PT with a BS or MS degree any day vs. a PT with a DPT degree...... Oh wait! This situation happened to me ... and the DPT was ineffective and the experienced BA/ PT helped me avoid surgery! Thankfully, I am still practicing what I love to do!

Jeanne October 29, 2015 6:08 PM

A few more questions worth asking:

How can an organization that only represents 17% of therapy professionals (according to Jacqueline) make decisions that affect all licenced PTs?

I wonder what groups make up the majority of APTA members that are making these decisions? (schools and larger companies?) I also wonder what prompted their recent push for severity based billing and telehealth reimbursement. Those sound like very profit driven goals... because, in the end, everything has to do with money, including (most definitely) the DPT. (Why else would a practice owner want to circumvent a physician referral?)

What good is an "autonomous" DPT when the APTA still allows PTAs to be managers as well as the exploding use of PTAs for direct care and PTs for evals? And the unfair market issues of competing against POPTs and HOPTs?

Finally (for now) why do tDPT programs cost so much? (A: academia is a business) They should record the lectures once and post them on or Coursera for something around $100 for the entire course series, in my opinion.

Josh PT October 24, 2015 2:14 PM

I question whether the APTA is able to focus on a goal such as "autonomous practice" regardless of how many members they have, since they try to represent so many conflicting groups (PTAs, PTs in private practice, PTs in POPTs and HOPTs). The APTA has already chosen to protect the jobs of PTs working in physician owned practices rather than fighting POPTs. And now with more bundled payment systems coming down the pike, I don't see how many private practices will survive.

I agree with Patt that the APTA should have had better foresight when switching to the DPT. I knew many APTA members who seriously questioned the switch when it first happened. So, I too am still confused about how it actually happened. It would be interesting, for posterity, to know the details. Might make an interesting read.

Josh PT October 23, 2015 9:13 PM

How did they (who?) miss this (what?)?  

It’s not about the money, Dr. Platt.  It’s about autonomous practice; functioning at the level of primary care (direct access, anyone?) and not at the level of a technician beholden to the referral source.  It’s about acknowledging, and understanding how to read and contribute to, the growing body of knowledge that supports our profession and recognizing that there is much more to know today than there was 10 years or 20 years ago.  It’s about being recognized as a “doctoring” profession and sitting at the table with the rest of the white coats, albeit we may still have to elbow our way up to that table.

I was there when the push for the DPT and tDPT happened and I don’t remember anybody offering me better pay or more security or greater perks in exchange for that degree.  Nor did anyone offer me anything like that in exchange for my clinical specialty.  In fact, all discussions about such things were couched in vague “may” language and summed up with “we would like to see.”

First and foremost,   my clinical doctorate and specialization is about giving my patients what they deserve, the best possible care!  Before I am overcome by an angry mob of Bachelor and Master trained, non-certified, and truly excellent therapists, let me acknowledge that a degree and certification are no guarantee of clinical excellence, but they go some distance toward hedging your bet!

You honestly thought an individually held doctoral degree would stave off the systemic ills of the health care system?  Even a blanket of sheepskin couldn’t change the trajectory of our current system!  The decline in reimbursement is a reflection of the error in our basic health care premise.  When you place the construct of health into the context of a for-profit system, well, what did you expect?  Whether we are talking about the private practice owner paying the staff therapist less in order to secure his meager profit despite shrinking reimbursement, or whether we are talking about mega-corporate insurance companies shrinking reimbursement to protect the stockholders and the $10M salaries in the ivory tower, the people who pay for our tragic mix are the patients and the professional staff.

It’s not about the money, Dr. Platt, and it never will be.  Instead of flailing and wailing about reimbursement and crying, “See!  I told you this degree wouldn’t get me anywhere!” shouldn’t we be pointing our fingers at the real culprits?

Why is education so expensive?!  How do we ensure enough healthcare professionals for this aging country if our students can’t afford to attend the programs?

Isn’t healthcare a right rather than a privilege?  Shouldn’t we be taking a close and objective look at this whole healthcare for profit scheme and be working toward real solutions?

You don’t like the direction your profession seems to be moving?  How much different would our profession look if, instead of 17% professional membership, we actually stood together and supported each other with a resounding majority?  We could have real lobbying power then to address reimbursement for PT services!  The APTA would truly represent the will of the many of us rather than the whispered voices of a few?  Oh wait!  Membership is too expensive?  The price could drop considerably even with modest increases in membership.

I bridle a bit at your suggestion that the “planners” of your debacle simply didn’t care.  When was the last time you met a physical therapist of any level of training that didn’t care?  I heard Tim Flynn summarize it perfectly when he described physical therapists as passionate about their practice, but passive about their profession.

You’re a smart lady, Dr. Platt, and I applaud you for having the courage to share your thoughts, but I really must ask you . . . How did YOU miss THIS?  

Jacqueline Randa, Physical Therapy - Assistant Professor, Touro University Nevada October 23, 2015 7:22 PM
Henderson NV

As a business owner I also see the declining reimbursements from the insurance industry, coupled with the increased copays and deductibles created by the Obamacare plans we see a decline in caseloads. DPT, MS, or BS degrees do not matter to the insurance industry. All they care about is getting the job done and doing the proper paperwork/documentation. Likewise, unless it's part of a company's marketing plan, most patients don't know nor care what kind of degree the person working with them has, again they simply want to get better as quickly and cost effectively as possible. The creation of the DPT degree was both a failed attempt at pushing the profession into the level of MD's without consideration of the insurance industry's reaction nor the false hope of inducing higher salaries and, as previously mentioned, a marketing ploy for the universities to make more money.  

As a business owner, I will only pay a PT (regardless of degree) what the company can afford. I think it would have been wise to have stopped at a Master's Degree.

Randy, Physical Therapy - Presudent/CEO, Pro Motion Rehab October 22, 2015 12:22 PM
Murphy NC

One possible "solution" to the negative effects of the DPT on current PTs would be to grandfather all non-DPTs. At least that would hold the APTA to their promise that the DPT would not negatively affect current PTs (which I think it definitely has). Other professions have done this.

Josh PT October 22, 2015 9:30 AM

Thanks for sharing your insights  I couldn't agree more and have said this from the start. With this trend came more schools and more available seats for the program.  Supply and demand is another aspect I think worth considering (just saying).  We have "Doctors of Physical Therapy" offices opening all over - they won't even consider those of us without experience without their DPT.  Crazy stuff. As a clinical fieldwork educator for many years  I have noticed a trend in the "entitlement" mentality coming from DPT students - as they are promised that their costly degrees will pay off and afford them the salaries of PhDs. With 30+ years of experience and still loving what I do and having a lot of energy left, it is becoming increasingly challenging to "hang in there" making salaries like we did 15-20 years ago.

Lois Doyle October 22, 2015 7:14 AM

As noted also as a DPT you do not get paid more than you would with a masters or a bachelors there is no accommodation for the higher level education in regards to pay for the amount of money that a DPT has to pay back nowadays

Kristina, DPT October 21, 2015 10:02 PM

My theory: I have heard that the DPT idea was first proposed by Stanley Paris (maybe this is hearsay), but it makes sense as the universities are the only ones who benefited from the DPT. The health industry does not react like normal markets and there is no way any reasonable person would expect insurance companies to pay more simply because of a DPT instead of a BS or MS. In addition, when the APTA chose to stop fighting for "Medicare Physician Status" classification for PTs, they sealed the fate of PTs as dependent providers and not independent practitioners. (It would have helped fight POPTs and HOPTs.)

What happens when students stop entering PT because they realize all of the issues and the shortage becomes even greater? The use of support staff (PTAs) has already exploded, and if PTA become more expensive, insurance companies and Medicare may begin seeking other options. What if Medicare simply begins reimbursing for other degreed professional programs (ie. athletic trainers) to start providing care? Could the DPT actually cause the entire profession to decline and be replaced by something more efficient? Like a game of chess, I wonder if the APTA has positioned PTs in a corner that is destined to lose at this game.

Josh October 21, 2015 10:00 PM
Chapel Hill NC

The same thing is going to happen when the push for BA level degree for the Physical Therapist Assistant goes through. A BA was once what was required of PTs. Will the PTA with a BA or BS be doing evals, manips and creating treatment plans? Will our work be accepted by all insurance companies? Will salaries go up to reflect the cost of two more years of education? Probably no to all the above. So what's he point? How do higher academic requirements benefit the profession and the patients?  

victor, PTA education - college lab tech, community college October 21, 2015 8:44 PM
brooklyn NY

I have been saying this for 10 years+. But the problem is that those involved in the politics of it all, are PTs in academia or hospital settings. Guess who benefits? $$$$$$ to universities!  At the time, hospital facilities made much more than private practices under facility fee schedules. Too late now.  30 years experience and I have to work 30% harder to make what I made 15-20 years ago.

Leanne, PT October 21, 2015 6:24 PM

Spot on as usual.  I'm glad to see that someone writing and stating the truth in what is really happening in the Business.  The big push t the higher degree was prompted by Academia to sell a bill of goods.  I see more and more shops going to cash based service because the reimbursement is so low.  

J Dyer, Owner October 21, 2015 4:51 PM
Clearwater FL

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