Toni Talks about PT Today : General Interest

October is PT Month

Toni Patt — Wed, 21 Oct 2009 12:30:00 GMT

Tomorrow morning my department is going to have a breakfast for all the PTs to celebrate PT month. The food will be provided by the OTs, STs and supervisors. Sometime next week the rehab unit is supposed to do something similar. I'll be surprised if that...(read more)

MANY CLINICIANS AREN’T READY FOR VISION 2020

Toni Patt — Tue, 22 Sep 2009 20:56:00 GMT

Last week I had the pleasure of hearing Rebecca Craik, PT, PhD speak. She gave her perspective on the past and future of physical therapy. As she is the editor of the Physical Therapy Journal she is in a position to talk realistically about what's ahead...(read more)

What is the Value of a GCS?

Toni Patt — Wed, 22 Jul 2009 13:17:00 GMT

Somehow this week during all the normal chaos of life I managed a major accomplishment. I completed and mailed my registration to sit for the GCS exam next year. I'm very proud of myself. Completing the application isn't very difficulty. Making the commitment...(read more)

Goals Must Be Based on Assessment

Toni Patt — Tue, 14 Oct 2008 20:14:00 GMT

Yesterday I got a real shock when I looked at one of my patient's charts. An OT had evaluated her and used my PT evaluation to write her transfers goals. On the surface this may not sound too bad. I don't understand how she could write goals on something she didn't assess. There was nothing in her evaluation about mobility, not even something indicating mobility as per PT. What's worse my evaluation was performed the day previous to the OT one. The pt's status could have changed between the two. I may be over reacting but I just don't see it.

Let me back up. The OT did do a bed level evaluation. Nothing on her evaluation indicated she moved the patient around. I'm not saying writing "mobility as per PT" and then writing goals would be much better. But doing that there would at least provide an objective basis for the goals. Besides what I wrote was very basic. By not seeing the patient move the OT missed all the intrinsic pieces that go into planning a treatment. I didn't mention hear or trunk control. I didn't describe exactly where the pt placed her hands when transferring or whether she consistently reached for the chair. Some things can't be extrapolated.

The whole point of the evaluation is to determine a patient's functional status. From that we write goals and develop a treatment plan. Sometimes I co-evaluate with an OT. If I don't assess something I see it being assessed. I may ask the OT what the UE strength is which will affect my transfer goals. OT will address the UE strength which also effects my goal. I'm writing a transfer goal, not a UE strengthening goal.

This concerns me because it puts us on a slippery slope. The evaluation is the key for skilled intervention. If OT is basing its treatments on PT assessments it could raise the question of whether OT is necessary since it would appear OT was working under PT. I must appease my OT friends by saying this isn't so. The same would hold if a PT wrote goals based on an OT evaluation. Bottom line, each disciple needs to do its own evaluations.

There could also be a licensure issue. If I assume the OT Practice Act is similar to the PT Practice Act there is something in there about assessments from which to develop individualized POCs. I could argue that skipping part of the assessment but writing goals is in violation of the practice act. I could be over reacting. Maybe I'm the only one who thinks this is a problem. It bothers me because this wasn't an oversight. This OT read my evaluation and decided to use what I wrote rather than moving the patient herself. It was a decision. To me there is no excuse for that. Assessment of transfers can be delayed to a later treatment if necessary. This just seems wrong to me.

THE APTA CONFERENCE IS IN TEXAS

Toni Patt — Thu, 12 Jun 2008 13:35:00 GMT

This I had to make a choice between taking my horse to Regional's in Fort Worth or going to the APTA Conference in San Antonio. As it turns out I couldn't do either one. I couldn't afford it. No one should be surprised that showing horses is expensive. What might be surprising is that going to the APTA Conference would have cost more.

I thought I would be able to go. San Antonio is only a 3 hour drive for me. Even with the rising cost of gas it's cheaper than flying. Then I started adding up costs. First there was the price of attending the conference (early bird). Second was the cost of lodging and food. Pre-conference courses were extra. Even if I'd driven up the morning of the 11^th, brought food with me and did nothing extracurricular I could not afford it. I admit that's pretty Spartan and probably not realistic.

The whole exercise raises two questions. Would it have been worth going anyway? How are other able to afford the cost? I would have benefited from attending. The actual Conference has a lot to offer. There would be some networking opportunities. I would have access to the displays and vendors. I just wouldn't be able to do the "fun" stuff. Realistically I would be doing nothing outside of the conference. This isn't St. Louis. There are no conveniently located White Castles around. Food and entertainment add up.

I also wonder how others are able to afford this. I don't think too many facilities are helping with the cost. The majority of attendees will have had to fly. This might result in the added expense of a rental car. The APTA encourages us to attend. Yet, I don't see much effort on their part to make the cost affordable. Early Bird discounts help. Using different locations throughout the US helps to a point. I wonder if attendance this year will be lower than previously. I wonder what the attendance was in Nashville compared to previously. Certainly if attendance goes on a continued downward trend the APTA will investigate. As a good friend says, this doesn't make any sense. Why push attendance at something priced out of reach for many members?

I don't have an answer. I do have a suggestion. The APTA should video the various presentations and lectures, burn them onto CDs and sell the CDs. I would pay for CDs of the geriatric portion of the conference. There are other lectures I would pay to hear as well, particularly those in education and administration. By including information on the presenters individuals could apply to states for CEUs. Maybe they already do this and I've missed the CDs.

This time I get to be jealous of those who've managed to go. Someday I'll go. Maybe I'll be lucky and a conference will be scheduled in Houston. I shouldn't complain I have plenty on my plate between, work, school and the horses. But as a therapist I want to go and spend time with others in my profession. I want to support my profession as well as learn the latest and greatest. As they say at the end of baseball season, maybe next year.

What if I Won the Lottery?

Toni Patt — Tue, 11 Mar 2008 15:05:00 GMT

Today at lunch we talked about what we would do if we won the lottery. Almost every one said she would continue to work but not at her current job. A couple said they would stay home and be mom. An ST said she would volunteer her time to help uninsured children. Others said they would still work but fewer hours. The difference, we decided, was doing what you want to do instead of what you do to get by. At the same time we wondered why all the good jobs pay less.

I would still be a therapist. That's all I know how to do. My practice would be different. Instead of working with the elderly in hospitals, SNFs and the like, I would like to do hippo therapy. I could combine my love of horses with my profession. For me that would be the best of both worlds. I could spend every day with horses and still provide therapy. The problem is, though the programs are successful and popular, very few exist. Those that do either hire volunteers or pay very little. So, I keep my current job which allows me to have horses.

Making the switch would be a complete change in direction for me. Currently I'm working on a certificate in geriatrics, preparing to take the GCS exam and considering enrolling in a DPT program. Hippo therapy would be something completely different. Geriatrics is pragmatic. I like working with older adults. It is also the fastest growing population requiring services. As more baby boomers reach retirement age, the need for therapists will explode. If I could I would switch without a second thought.

Now, if you had asked me 10 years ago about my dream job I would have said management. I've done that. I could do it again. It just isn't a burning desire. I'm not sure if the change is experience talking or a change in my priorities.

I think everyone has a perfect job they would prefer to do. Some people would go back to school and change careers. Others, like me, would stay in their careers but change what they do. I know some people who've managed to make it happen. I'm jealous. I envy the woman who trains my horses. I would love to do what she does. Meanwhile she talks about wishing she had chosen a different career path. Wouldn't it have been nice to have had this knowledge when choosing a major in college? Or to be able to go back to school to be able to make changes? The problem is everything costs money and there is never enough to go around. Well, at least I have something to think about.

Back in the Lab Again

Toni Patt — Wed, 27 Feb 2008 21:28:00 GMT

I spent last weekend in Dallas. I had to go there for a lab for my online class. Three one day labs are required. This was the first. It was also my first venture into onsite graduate education. My first class was 100 percent online. All the lectures were downloaded. I completed assignments and submitted them electronically. I never met anyone fact to face. Even though I was doing school work it didn't feel like school. Working at my computer with my parrot on my shoulder just doesn't feel like school. Being in the classroom and sitting at a desk felt like school.

The most exciting part of the agenda was a visit to the anatomy lab. Since this is a cardiology course we looked at hearts and related structures. The first thing I realized when I looked at those things was how much I've forgotten. The second thing I realized was how much I've learned since I took gross anatomy. I learned more from that hour in the anatomy lab than I would have gotten from hours of lecture and textbooks. There's nothing like seeing to understand. When I looked this time I knew what I was looking at.

My memories of gross anatomy are of struggling to identify structures while memorizing origins, insertions and actions. I might have looked at something else but I wouldn't have remembered it. My entire focus was on learning the anatomy and passing tests. I didn't have time for added significance. This time I knew the anatomy. Instead of focusing on what I considered why and how. I know the aorta carries oxygenated blood. I'd forgotten how large it is. I know what a AAA is. Now I know where it occurs. I had the opportunity to feel calcification in an artery. Now I know the mechanism by which it causes problems.

This got me to thinking. What would happen if I were able to retake PT school? Would I learn all kinds of new things that I missed the first time? I know I would ask different questions. I wonder how much I missed as I struggled to put a whole lot of information into my head in a seemingly short time. Would I be a different therapist now? I'm certainly a better student. Of course one class a semester is a little different than a full course load. Back then I dreaded exams. Now I look forward to them to as a chance to use my mind.

At lunch the four of us sat around talking about school. We all felt the same way. We are in school now because we want the knowledge. We want to do the work. We're all about the same age so that might slant our opinions. That doesn't mean it isn't something to think about. I work with two therapists who have about 4 years experience each. Both have master's degrees. One is adamant about never returning to school. The other expects to in a few years. Compare that to people almost 20 years older having a similar conversation at lunch. It makes me wonder.

Right now I'm enjoying myself. I'm working on a certification in geriatrics which only requires 4 classes almost all of which are 100 percent online. I might feel differently if I was looking at a 30+ hour curriculum or actually had to go to school. I've also been out of school more years than I want to admit. That might make a difference. Right now I'm learning things I can use immediately. That's what is important.

*** Anyone interested in the geriatric certification should go to http://www.twu.edu/. Go to the school of PT and follow the prompts.

I Lift Patients For a Living

Toni Patt — Wed, 23 Jan 2008 21:07:00 GMT

This week I started wondering about something. When did physical therapy become synonymous with getting people out of bed? For the last week it seemed like all I did was get patients out of bed. Now out of bed is a good thing. It increases alertness, allows for greater lung expansion, increases endurance and facilitates head and trunk control among other things. It's important that patients get out of bed daily. That isn't my problem. My problem is that it seems like PTs are the only ones who do this.

Yes, we get people out of bed. I admit I've gotten up some nearly comatose ones. I had reasons. One of which was to assess how the patient transfers. Another is to incorporate the transfer into something therapeutic. Transfer training is only one modality performed by PTs. I can treat a person without doing a transfer. If I want to work on balance I might sit the patient on the edge of the bed or stand at bedside. That patient will still need to get up that day. If all of my treatments are transfers, I'm short changing those patients in what therapy they receive. Mechanical lifts exist to make transferring involved patients easier. There's nothing therapeutic about it. Anyone on a nursing floor should be able to operate one.

That is the basis of the age old turf war between therapy and nursing. Who is responsible for getting the patients out of bed? There seems to be a belief that possession of a gait belt provides its owner with superhuman powers including the ability to lift small automobiles. I wish. If that were true I'd be handing gait belts out to everyone. My biggest pet peeve is being asked to help get someone out of bed. Then when I go to help, the asker disappears. Or, the asker then tells me she can't help because she doesn't want to hurt her back. I'm not sure I understand why it's OK for me to risk hurting my back. I'm sorry to say it's almost always women who ask and walk away. Men will try to help.

This week I was nearly pushed over the edge by two OTs. I like OTs. I respect OTs. Not being one, I can't speak with complete confidence to what they are taught. But I would guess somewhere in there is some transfer training. These two ladies must have forgotten. For the entire week they sat at their table and waited for the PT to get the patients up and bring them to the department. This wouldn't really surprise me from another discipline. When I confronted these two they said, "These patients are heavy and I don't want to hurt my back."

Physical therapists are caught in the middle. We know patients need to get up. We also know that in many cases, if we don't do it, the patient won't get out of bed that day. The only one who suffers in that scenario is the patient. So we get people up. I only have so much time with patients. I hate to waste it getting them up when there is so much else to work on.

Patients have gotten bigger and sicker. They are more involved. They require more care than previously. The same treatment principles apply now as did 10 years ago. Patients get better faster when they get out of bed. It would be nice if all the disciplines could work together on this. I know it does in some places. In the mean time, I did not go to school solely for the purpose of getting patients out of bed. If a patient needs help, I will help them. That's what PTs do. I would gladly hand over my magic gait belt and all its superhuman powers to anyone who would like to borrow it.

Experience Counts

Toni Patt — Tue, 15 Jan 2008 16:40:00 GMT

An OT friend and I were talking the other day. Between the two of us, we have almost 50 years of experience. There doesn't seem to be that many of us "old ladies" around any more. Frequently I'm the most experienced person in the facilities where I work. Almost all new hires I've met have had less than two years experience. My friend and I are part of a vanishing breed, or so we think.

On many issues, the two of us think the same way. Our favorite topic is that we are too old to keep doing this. We go home from work tired. We feel heavy patients for days after we work with them. We talk about what we would do if we quit being therapists. So far we haven't come up with anything. Therapy is all we know how to do. With our experience, we're very good at it. We also agree that our experience doesn't seem to be worth much any more.

We feel unappreciated. Employers don't want to hire us because they don't want to pay us what we're worth. Back in the day it was considered a coup to hire someone with experience. In return, that someone was expected to help others learn. Now, employers look at the bottom line. If experience costs money, they don't want it. A few weeks ago I was working in a clinic that hired a new grad DPT to take over a brain injury program. She had no neurologic experience. She had no experience at all. She will learn. While that occurs, the quality of care is going to drop. The amount charged for that care won't change. There is something wrong with that.

We've also noticed lack of respect from co-workers. I'm not talking about everyone. I'm talking about one or two who pop up. These people seem to think that because we don't know the latest buzzwords or follow the latest research our knowledge is questionable. I may not have the evidence. But I have the experience to know which treatment works best or when one treatment is better than another. I worked in a clinic like that. Everyone knew a lot about one thing. No one knew how to treat something out of the ordinary. I did. I also knew how to handle difficult patients and was willing to work with the lower-level patients.

The therapies are a hard occupation. At times it can be manual labor to move patients or transfer them. If I want to do a therapeutic transfer I'm not going to use a Hoyer lift. I'm going to physically move the patient. Treating patients wears us down. If we're not lifting, we're rushing to meet deadlines or treat double- or triple-booked patients. More and more often I go to work and wonder if I can get through the day. High-cost, super-strong coffee is becoming a necessity rather than a treat. Those of us who've been doing this a long time have paid a price for our experience.

Now I sometimes feel my profession is forgetting about me. The latest push is on the youth who will become DPTs and move the profession forward. In Vision 2020 there is talk of all the things the DPT will be doing. I have yet to hear where I fit into the picture with my bachelor's degree. I'm not going to retire before then. Right now I don't know what I will do. I hope my profession recognizes the experience and knowledge I have developed for the assets they are. I hope it recognizes the value of experience. Maybe movement in that direction will open the eyes of employers. I can hope. In the mean time my friend and I will keep plugging along doing what we do best.

Don't Call Me

Toni Patt — Thu, 10 Jan 2008 15:30:00 GMT

Recently I've noticed an increase in the number of calls I've been receiving from recruiters. Out of curiosity, I started listening to the messages. I like to know which facilities are chronically short staffed and which are suddenly hiring. Besides, there's nothing wrong with comparison shopping.

Just for the fun of it, I returned some of the calls. Every recruiter was similar to the others. Everyone wanted a resume before they would tell me anything. They all made references to opportunities in my area but were short on specifics. No one would even tell me the type of facility or which part of Houston these jobs were located. After a few calls it became apparent everyone was trying to fill the same openings.

I could save those recruiters a lot of time if they would listen to me. I can tell them why no one in Houston is interested in those jobs. The first one, just outside of Houston, is actually a little over 150 miles away and would required relocation. I don't care how much the sign on bonus is, I'm not relocating. Apparently no one else is willing to do so since the position is still open. The second is with a company that has a bad reputation in the local PT community. The third is a one-man show in a nursing home in a system that is always trying to hire therapists.

I asked a few of them about positions I knew were available. No one was willing to call the facilities on my behalf. One told me I was mistaken, that particular facility didn't need anyone. Another told me not to try because the competition was too hard. Every single one of them had a reason to discourage me from being interested. They all had something better they just couldn't tell me about without a resume. I guess those places don't pay the fees recruiters charge. Or, maybe the recruiters are more interested in making money than helping me get a job I want.

My favorite was the man who called me on Friday about a position that I was interested in. He was going to set things up for me. By the next Tuesday the position had been filled. Instead he had a position that was only 23 miles away from me. The first one was about 10 miles. He just couldn't understand why I didn't want to drive an hour to work every morning and pay $8.00 in tolls round trip. Coming in second was a company that tried to get me to interview for a position that had already been filled.

I don't know why recruiters do this. It is misleading and dishonest. Bait and switch doesn't work in the job market. All it does it make them less believable the next time. All I had to do was ask a few questions to reveal the deception. I'm not saying every physical therapy recruiter does this. I can only speak for the ones I spoke to in the last two weeks. I wonder if these individuals really think I wouldn't figure it out. This kind of thing doesn't help therapists. I'm sure there are many of us out there looking for jobs and getting this very run around. I have a suggestion for those facilities having so much trouble getting staff. Look at yourself and clean up your act. Offer a decent salary and good working conditions. You're not going to have any luck using these recruiters and being dishonest.

Time Out

Toni Patt — Thu, 03 Jan 2008 16:31:00 GMT

New Year's Day I took a time out. I looked at all the things waiting to be done and ignored every one of them. I was tired. I needed a break. Instead of doing things I had to do, I did things I wanted to do. I came to a realization. The day needs to have more than 24 hours in it if I want to accomplish everything and still have time to sleep. Americans are chronically tired and overworked. An entire industry of blessedly strong coffee on demand is thriving because of it. Because of the demands of our job, therapists are feeling this on a daily basis.

The profession of Physical Therapy has unique requirements. CEUs must be earned regularly. Skills must constantly be kept up to date. Reimbursement regulations are constantly changing and need to be followed. APTA members are encouraged to attend district meetings, state meetings, combined section meetings, become involved with the organization and donate to the foundation when we have a moment. I'm taking online classes in geriatrics. Sometimes I need to seriously think about the DPT. Whether I agree with it or not it's the reality and it's here to stay. In the course of a normal workday there are meetings, families, phone calls and documentation all demanding attention. In Houston we have the added obstacle of the commute. An average drive can easily be an hour one way. That's time spend in the car not getting anything done. All of this happens before I get home. My respite for the day is riding and working with my horses. Then I go home and simultaneously must let the dog out, greet the cat and free the bird from his cage. I can't imagine what it would be like to have children. My hat is off to those that do.

Other ADVANCE blogs have touched on this. I need to examine my life and organize my priorities. If something isn't necessary, it isn't a priority. What is important to me? The answer to that question is the basis of the decisions I make. Sometimes we forget that. It's easy to get caught up in things and lose sight of what is important. I need to step back from overachievement and be happy with being good at what I do. If I relax and do my job the day usually goes smoother. By nature PTs are overachievers. That's what got us here in the first place. It's also what gets us into trouble.

I'll be a better therapist if I take care of myself. That means remembering my priorities and following them. I must learn to say "no" more. It's a simple word of two letters and just one syllable. Yet "no" is one of the hardest words to say. Work is only a job. It isn't me. Life is what happens outside of work. My life is me. I want to spend time with my horses. It's up to me to make that happen. I may not make many changes in my life. Maybe I'll just take more days for myself and do what I want to do instead of what I have to do.

A Tale of Two Christmases

Toni Patt — Wed, 26 Dec 2007 16:04:00 GMT

Christmas will be past when this is posted. That doesn't mean I can't have a Christmas topic. In this case I refer to the annual Christmas party. Yes, it's time for the big event where everyone sits around and overeats. I don't know about anyone else, but I hate the things. I'm not a party person. I look for reasons to not attend. I don't like Christmas cookies. I'm not fond of eggnog. To me, putting a Santa hat on someone just makes them look funny. Still, tradition is hard to fight. Every year I'm exposed to some version of Christmas cheer. Two recent parties come to mind. Both were sponsored by facilities. Both were open to everyone. Only one of them had any kind of Christmas feeling. The difference wasn't in the party but in the message it gave.

Last year I was a manager so I had some knowledge of the party planning. It's not a good sign when the priority is having the party at a time when no one is on the clock. I'm not sure what they thought we were going to do. No one ever stays very long at those things. The decision was made to have it after hours. Could they make it any less convenient? People have lives outside of work. They have obligations. Sometimes it's just not possible to stay late even for a good reason. The party was catered and held in a rented conference room. The entire attendance was upper management and the department heads. We stood around looking at each other trying not to be the first one to leave. Nothing screams Christmas like finger sandwiches-limit two-warm punch and dead air. What were they thinking? I still don't know.

This year the party I attended was held at lunch. When I say lunch I mean turkey, ham and all the fixings-including cold sodas, ice tea and coffee. It was catered but held on site. Management worked the serving line. Seconds were encouraged. No one looked at the time clock or reminded anyone that there was work to be done. The room was packed. The biggest problem was finding a seat. The nursing staff bent over backwards to make sure everyone got to go and eat. This one screamed Merry Christmas and it cost a lot less.

Obviously there is more to this picture than meets the eye. These parties reflected what was going on inside the facilities. On one hand, we have Scrooge counting every penny. On the other we have Santa saying, "Come on in!" On one hand, morale was low. On the other everyone was happy. The first place had (and still does) a chronic problem with staff retention. The second place rarely has turnover. Something else is going on. The first place truly meant to have a nice party for the staff. The problem was the staff didn't see it that way.

That is the problem. Management and workers don't agree. In a world of budget cuts and poor reimbursement, everything revolves around the bottom line. Employees have stopped being a valued asset. Instead, they are a line item cost. Both sides know this. In the case of the parties, the difference was in the presentation. The second place could have told everyone there wasn't much money so all they would do is buy lunch. Instead, they made it an event an encouraged everyone to come and eat. No one got any overtime. The patients continued to be cared for. Everyone had a nice lunch. Having the party after work so people will clock out first sends the wrong message. The employees weren't mad about not getting overtime. They were upset about how they perceived they were being treated. No one expected much. While the intentions were good, the message it sent was the wrong one. It's sad how such a joyous holiday causes so many hurt feelings.

What Will You Do?

Toni Patt — Tue, 11 Dec 2007 13:44:00 GMT

What will you do if something happens to you? What if you have a catastrophic stroke? What if it is your parent in ICU barely hanging on? What if your child is born with spastic CP? What if your brother is involved in a terrible accident? There are endless possibilities. What if your life changed forever? Do you ever think about it? I do. My big fear is a stroke and loss of independence. I practice using my left arm in case I lose use of my right one. I know, only a PT would think of that.

No one knows when something will happen. These sorts of tragedies are almost random as they can't be predicted. The elderly don't plan to fall and break a hip. No one schedules a car wreck. Parents don't expect to outlive their children. These things happen. In what can seem like a blink of an eye your life can change forever. I like my lifestyle. I've worked hard to get here. If things changed I would be angry. I don't want to give up my home. I don't want to become the primary caregiver for a family member. Yet it happens all the time. Most of our patients find themselves in this exact predicament.

As therapists we have one advantage. We are familiar with the medical world. We understand the terminology. We've been exposed to the process. I don't know if this really helps. I've never had to deal with it. Sometime in PT school I realized this could happen to me. It's been in the back of my mind ever since. I have thought about what I'll do if I get a phone call telling me someone close to me has been injured. I am amazed how some people can rise to the challenge. Some of the nicest patients I've worked with have been significantly involved. I've seen family members drop everything to step in and care for a loved one. I don't know how they do it.

For me, the worst part will be the loss of control and the suddenness. I tell myself I'll be prepared. I tell myself I'll see forward into the future. I hope I'll be a good patient. Somehow I doubt that. I'll be the one telling the therapist she isn't doing it correctly. I'll be debating the physicians about alternative treatments. Some people would call that a personality disorder. Others would compliment me on how well I'm handling things. I don't know what will happen in the future. I concentrate on today. I just wonder if anyone else thinks the same way.

So You Want to Be a Physical Therapist

Toni Patt — Wed, 05 Dec 2007 13:53:00 GMT

I read the comments about last week's blog with interest. I noticed several references to reconsidering physical therapy as a career choice. That got me thinking. If I had to do it today would I still choose to become a PT? I don't thinks so. I couldn't afford the cost and I couldn't make the time commitment. Back in the day (1980s), it was a four-year program. Post professional education didn't exist. I was able to work my way through college and earned my degree with minimal debt. It wasn't easy, but I could do it. If I hadn't have been able to work, I wouldn't have been able to go to college.

Today it's different. The time commitment can be seven years or more. The cost is staggering. Working while in PT school is practically unheard of now. A person could graduate and then spend the next 10 to 20 years paying off debt. That combination puts the profession out of the reach of many individuals who would make excellent therapists. These are people who want to be therapists for the right reasons. I have yet to hear one comment from the Vision 2020 group addressing this. I don't quite understand how setting the cost at the point it discourages those who would make the profession stronger helps the profession.

In the comments there was also a debate about salary and level of education being disproportionate. I wasn't aware there had to be a linear relationship. The problem results from the high cost of education in a world with decreasing reimbursement. Reimbursement rates will continue to decline. In that environment, salaries will not increase. To say that is causing a crisis in health care is an understatement. The reality is-beyond a select few-no one is going to get rich being a physical therapist. A decent living can be made, but there is a salary ceiling.

I am a one income individual. On my salary I am able to own a home, truck and two horses. I have a question for those who say the salary is too low. What income level are you shooting for? If money is your goal, there are other professions that pay more with equal or less education. Maybe you should consider one of them.

Prestige was another comment thread. We must have it. If I hear that one more time I am going to lose it. My dictionary defines prestige as "prominence or influential status achieved through success, renown or wealth." My dictionary is a little old so the definition may have changed. To me that sounds like wanting status because you have a title-not because you did anything. I would rather have respect. Do I have to define that? Respect is earned. As defined, prestige sounds like it is given automatically. In that case, anyone with a certain title has prestige whether they deserve it or not. If you want status, become a physician, run a corporation or win the lottery.

Sadly, in these discussions about becoming a therapist and what it means to be a therapist, I saw no mention of providing patient care. I read nothing about providing quality care that makes a difference in someone's life. What happened to being a therapist to work with children? Or to work with athletes? Or because a therapist made a difference in your life? If becoming a therapist depends upon money and prestige, I think we were better back in the days when I went to school. I wonder if Vision 2020 took that into account.

Now Hear This

Toni Patt — Fri, 02 Nov 2007 12:55:00 GMT

I've been a therapist for many years having graduated in the 1980s. I've seen things change. Trends have come and gone. In many cases what we do now didn't exist then. I've seen my profession grow to a major component in modern health care. I've seen good therapists, bad therapists and a few I'd call exceptional. But only recently have I seen this. Therapists who've stopped caring about what they do.

What has happened? When did we place money over providing care? When did we start choosing continuing educations courses because they were cheap and easy rather than to learn something? Why is it acceptable to pass off challenging, time consuming patients for the quick and easy ones? ( I'll have more to say on this one later.) When did hot pack, ultrasound and massage take the place of good old hands on? Certainly some blame lies squarely at the feet of the payment sources. More blame lies on health care facilities who value numbers over quality. Ultimately it is the individual therapist who makes these decisions not Medicare, administration or any other outside force.

This isn't everyone. There are so many good people out there who would do anything for a patient. But there are those who don't care. Or, maybe they just don't know any better. Ignorance is not an excuse. The ones who suffer are the same ones who depend upon us the most, our patients. If we're not going to help them, who will? Everyone takes the occasional cheap course or cuts a few corners. One of the buzz words for this phenomenon is disengagement. I have a few different ones: burned out, exhausted, fed up and indifferent. For those of you falling into option number four, I have a message. Get it together or get out. And please, take those therapists who only know one way of doing things and don't want to know another with you.