A Day Without an Assistant

I have wanted to bridge the gap for years and the only place I know of requires you to study on line and spend weekends in Finley, Ohio for clinicals. Online is the way to go I have 10 years experience and so ready to take it on. This is far and would requirer a super hero to hold down my full time job, home and family. Is there any other options?? sincerely, Caryn

This dialogue is interesting however what exactly is being done by the APTA to allow PTAs to bridge to PTs? Do they even acknowledge us? LPN to BSN, or RN to BSN to MSN are valid examples on how to structure a program for PTAs. What about programs that are currently available for COTAs to bridge to OTs? What I don't understand is how can BS PTs have at their disposal numerous on-line transitional programs to MSPT or the T-DPT.

How much measurable added quality is there with a PT treating a patient compared to a PTA?  Is the higher education of a PT producing better outcomes?  How is adding additional education for PTAs going to increase quality of outcomes?

It seems to me that a BS PTA is not going to produce outcomes that are much better than the AS PTA.  I'd be interested in seeing data showing that the new DPTs provide care that's significantly different than the BsPTs.  What do the increased educational requirements really do that is clinically beneficial?

As for the PTA to DPT transitional programs, my question is why are there only two programs?  What is the rationale to only having two?  Wouldn't the PT profession benefit from having PTAs, people that have experience in the field, advancing to the DPT over say some med school reject that "settled" for PT school as a backup plan.  If they have all the prereqs what's the issue?  You'd have more PTs that have made the career decision based upon what they've experienced rather than what they read in "Hot Jobs 2009" magazine (<<not a real magazine.)

I've heard the concept that the PTA profession is looking to be phased out.  I'm not sure how this will be possible though.  You have more and more people that are going to need services.  There are not enough PTs to handle the load.  On top of this your DPT has significant student loan debt most likely while there PTA counterpart has very little.  This debt will most likely result in the DPTs requiring a higher salary.  Along with this additional expense for the clinic/hospital/nursing home, they are likely going to be faced with reimbursement cuts.  Increased expenses and decreased revenue will create even more demand for the utilization of the less expensive PTA practitioner.  

I hear people saying the future of the PTA is uncertain. what I see though is the PTA isn't going anywhere and is going to be needed more than ever in the years to come.  Requiring a BS for the PTA is only going to result in degree inflation, a concept which still needs to be proved for the DPT that it's not just the same thing.  Where is the data?

  Jason I love the fact that you have spoken out and are ready to act on behalf of the PTA profession.  I'm not sure however, if a “sick in” is the most effective or professional way to advance the cause. I feel as strongly as you do about the lack of effort and initiative the APTA has put into the advancement or development of the PTA profession.  Other than an Advanced Proficiency certificate that may or may not be portable outside of the setting you are employed, the APTA has shown little concern in the professional development of the PTA.  The APTA has failed the PTA. The past 15 years or so have been both frustrating and concerning to our profession.  We have stood by and watched the advancement of the PT degree evolve from Bachelors, to Masters, and now to a DPT degree.  The lack of attention to the PTA profession extends even to the board where PTA representation is scarce or nonexistent.  I for one know there are many of us who feel we have been overlooked in many ways.  

There are many PTAs who would relish the opportunity to advance to a PT degree.  The question may be are they ready and willing to face the challenge if given the opportunity.  I believe a surprising number of PTAs are ready and able to bridge the gap. Of course there will be some who are satisfied at their current level in the profession, and that’s great.  I think however, many of our peers are ready to pursue some form of advancement.  I have over the years found it difficult to fathom why the APTA has not developed any kind of bridge program for the PTA. Patient census is bound to rise with the upcoming baby boomer population.  The possibility of a shortage of facilities and the clinicians to adequately man them is inevitable.  

One would think the APTAs focus would be to work with their existing base, their fundamental frontlines, the PTA.  There is certainly something to be said about the experience and skill level obtained by veteran PTAS.  I think I speak for many of my peers when I say the APTAs efforts over the last several years seem to have concentrated on the advancement of the PT profession, leaving the PTA profession neglected and stagnant.  I think this has further distanced the two.   This is a huge disservice to the accomplished and seasoned PTA.  Many others may say “the PTA is simply not equipped to take on such a task”.  I feel this would create a recipe for knowledgeable and outstanding clinicians.  I say provide the opportunity and you just might be shocked at better turn out than some expect.  

I think our clinic feels the impact each and every time we simply take a day off for vaction, sicktime, or personal reasons.  Infact I was sick this last monday.  We had a moderate schedule of about 32 patients.  Staffed with 2 physical therapists, one aid and one front desk person.  The clinic struggled.  I could see that only 2 of the 32 treatments were documented and billed.  When we are busy I work extra hard, when we are slower, I still work hard usually carrying the entire patient load while the Therapist, talk or work on their projects.  

What we really need is a transition program that will allow the PTA to continue to work full time.    Dan Green PTA, FOC, Exercise Physiologist

Hi Jason,%0d%0a%0d%0aI am a PTA down here in Canada and follow all of your blogs religiously. I have been away on a holiday so am just catching up with what I have missed. I totally agree with what you are saying and what you are trying to accomplish. However, I do have to agree with some of the other resposes. To have this "sit out" would indeed send a message, but to whom, would the right people hear what we are saying. Personally, I became a PTA because it was a career change for me. I have a business degree and after a few years, needed a change.  One of the best skills that I brought with me was customer service and I feel that in the "big picture", our clients would have the most to lose. If this went nationally or internationally, how many of our clients would be neglected. In some areas of rehab, and thank god  it does not happen here, there is a lot of animosity between some PT's and PTA's

We all know the impact would be if PTAs decided to a sick in, in fact if any profession healthcare related or not decided to a sick in will have the same damaging effect to the work flow. If a large majority of PTA's for some reason decided to move forward with this idea, we would do a disservice to our employers , peers not to mention our Pts and clients. What will this form of "strike" really accomplish. To move forward regarding a bridge program advocate(s) is/are needed especially one who sits on the APTA board who will have the vision ,insight and courage to proposition and expand this concept . If PTA's are not responding it may be because this form of demostration is not the best medium to be heard.

Reading Steven's comment was a "Wow, I shoulda had a V8" moment for me.  It sure is easy to loose perspective and get a narrow focus.  

The lack of response could be that the nonvocal PTAs are content with where they are.  That is altogether different from not caring.  Maybe that is the question:  Are you content with your current professional role as a PTA?    

Maybe this issue is a case of the vocal minority speaking out.  That does not make their desire any less valid.  Those who desire to change course and pursue a different, yet similar, path are to be respected.  But those whose initial chosen path still fulfills them--they are to be respected as well.  

I have known a number of PTAs who had the option to be a PT, but preferred to be a PTA.  Maybe silence is the voice of contentment.  

Jason, take a look at Lisa Lombardo's blog " PTA weigh in" there are several PTA's with comments similar to your respondants. I believe some PTA's are satisfied at their present level and position in comparison to LPNs, however LPN's do have  the option to advance professionally as previously mentioned by a respondant. No one is looking for an easy way to become a PT, however there are PTA's who are gifted with talents that can become outstanding clinicians and there are some PTs who after a couple years of practice finds PT was not a good career fit. PTA's are not PT wanna be's . PTA school was a good route to get into Pt care. I believe experience is the best teacher.  When you get a seasoned passionate PTA enter a PT program the result will have clinicians with desire and knowledge to excel in Pt care and move this profession in the right direction.

Janey,

Agreeable, I do wish more PTA's had spoken for or against this idea.  

Unprofessional...I could debate this.  Change happens with action.  

I appreciate the comment.

Your desire for dialogue is good.  Your desire for action is admirable.  But, I agree with Christie.  But, I do wish a PTA had spoken up and made her point so that stigma would not be attached.  Christie's view has nothing to do with her being a PT.  Except pehaps that her status as a PT removes her emotionally from the process, allowing her to look at this rationally.  A sick out does not convey professionalism, regardless of what (or how many) initials come after your name.

The question is, "Are PTAs not responding because they recognize how unprofessional this call to arms is or are they not responding because they don't care?"

Unless you can answer that question you won't know if you are asking too much or asking the wrong question.

In an earlier blog (can't remember whose now) I commented about how the national organization of community colleges is recognizing the need to bridge the gaps that exist between K-12, 2-year colleges, and 4-year universities--and beginning to take steps toward that end.  I mentioned that in 20+ years I have never heard of this organization or any attempt on the APTAs part-or PTAs as a group-to communicate with it.  I tossed out that this might be a place to start.  To my knowledge there was not a positive response to that idea either.  And that was a professional concept, but perhaps the wrong idea.  

If there is someone out there actively pursuing this (or knows of someone who is), they need to speak up so the PTAs who are interested in doing have a productive outlet for their energies.

Or maybe the interest is in complaining, not in doing?  So I'll take it one step further than Jason...those who have no interest in doing, should not only stop requesting transition programs but also stop whining about their lack of options.

Karen,

Yes I am disappointed in the lack of support and unity with the PTA's.  I would have expected more dialogue from them.

Am I asking for too much right now?   Like I said if there is no support we as PTA's should stop requesting more transition programs.  

Nice debate.

Keep it focused on whether the PTA's will band together and join a day at home with their family.

The impact will be felt by the facilites.  Honestly Jason I don't think you will find much support from the PT's because they may not really care.  I certainly do not belong to the APTA so why should I tell them I support you.  How will it benefit me as a PT.  If we keep the PTA's where they are our jobs as PT's are more secure.  More bridge programs causes more competition from the PTA's who transition.

In all reality, the idea is good but the support from the PTA's is lacking.  You and Christie are the only ones talking about it and the PTA that did respond didn't want anything to do with it.  Maybe the PTA's aren't ready yet.  Keep trying.

Christie,

Back to one of my questions.  Did you tell the APTA you support more bridge programs for us and what did they say?  

Yes, my advancing to a higher degree was years in the making and I spoke openingly about it in Advance print since 1998.  I am adamant about PTA's advancing educationally to close the gap so to speak on our PT counterparts and make us better clinicians.

As far as being more prepared I beg to differ.  There are PTA's with more AND less experience than me as a PTA who have changed the way I practice because of the wonderful techniques I have seen them do and the knowledge they continue to possess.  And not everything I learned from them was about therapy.  

Knowing limitations in my knowledge has made me strive harder to become a better clinician for the patients.

And if given an opportunity to advance to become a PT through an online program I could do even more for the patients I see.

Sherlock Holmes lives at 221B Baker Street, Theodore Sturgeon was a science fiction writer, a Meadow Hay Opening is a chess move.

Ah, yes, remember Jason, that you have some advanced education that many of your counter parts do not. Surely, your experiences as an educator and your education in psychology have advanced you as a professional (I hope).  

Remember, that the majority of your fellow PTAs do not have the luxury of knowing what you know. You are certainly more prepared to enter a PT program than many of your colleagues.  

I have the privelidge of working with a couple of PTAs who have chosen to progress to further degrees.  They are certainly well prepared to enter a PT program...but we must remember that this is not the majority of those who are PTAs who still lack basic fundamental knowlege of the basic sciences.  Yet, this is exactly my point, why cannot there be a transitional degree that allows the PTA to progress to an intermediary step without having to drop everything in their life and committ to a full time PT program (aside from the two bridge programs)?  This should be a degree that benefits both the employer and the PTA...otherwise, it's for the PTA's benefit only.  Yet, this is an arguement that PTAs need to make for themselves.  An employer who encourages their PTA to transition to a PT is commendable, but not fiscally feasable in most cases.  It would be much more cost effective for the employer to let the PTA go and hire another PTA in their place as that PTA transitions to a PT degree. In contrast, if that employer somehow benefitted from the PTA transition (as I mentioned above, a transitionary degree that allowed more autonomy than a PTA, but still not quite that of a PT), then the employer has reason to encourage the PTA to make such a transition.  

True to form Christie I will recant and restate.  

Education in any form will make us a better person and clinician including psych and science courses.  

You mention values and statisical differences and I appreciate that.  I see a real value in knowing and understanding these in a clinical sense.

Knowledge in all forms is valuable.

Knowing who lives at 221B Baker Street and knowing what Sturgeon's Law is has come in handy.  Also, the ability to discuss the pros and cons of a Meadow Hay Opening has allowed me to advance a patient further than other therapists.

Robert, perhaps... It had been tired before by an OT. (I currently do not recall his name)  His attempt was to get both OTA's and PTA's in an association, Advance print did a small piece on him years ago.  I tried to contact him a couple of years ago but there was no response.  We could try again though.

You don't think having more psych and science makes you a better PT?  

Next time you have a patient with a history of schitzophrenia and you notice dysdiadokinesia, realize that without your psych, bio and pharmacology courses you may miss the fact that your patient is being overmedicated and may have a permanent movement disorder unless you contact that physician.

The next time your patient with COPD wants to turn up his O2, you might miss the fact that you can push them into CO2 retention and elevate their PaCO2 due to the HCO3- in the blood.  

The next time you evaluate a piece of scientific literature that discusses peak torque or some other force measurement, will you know what it is and will you be able to translate that to the usefullness of that piece of evidence.

Will you understand clinically statistical difference versus nominal differences in in patient who've taken the Oswestry Disability index or the Berg Balance test.

Will you be able to comprehend and explain to a patient why they are having cramping when they have taken too much of their diuretic?  

Jason, it's easy to say that the core science classes upon which physical therapy are built will not make you a better physical therapist when you haven't had them or seen how the PT courses themselves use this information.

You need the chemistry to understand the biology and phamacology, you need the biology to understand the process of movement, you need physics to understand kinesiology.  

Simply put, you will be a better physical therapist if you understand WHY things are happening as opposed to just memorizing facts.  It's only with the core sciences that you can better accomplish this.  

I believe there is a better way to convey our fustration about the lack of advancement for PTA's than having a sick out.  It is not the facilities fault of the restrictions that we the PTA's have.  Maybe starting our own affiliation to fight for us instead of relying on the APTA is a start, and with a strong enough voice we can have change.%0d%0a

I understand the frustration.  Without lack of advancement where do you go?  Some great PTA's will leave the field and that will impact patient care.

Correct statement, the APTA has not done enough to advance the PTA and that is sad.  Hopefully they will open their eyes and ears and promote the field of the assistant.  

I say go ahead and have a day to relax at home.  Yes the impact will be felt by every facility that has PTA's.  The PTA's have the numbers to truely change how health care is delivered.  Let's see how the APTA and facilities react to this.  I sense if this is a success you will see a change.  

The squeaky wheel gets the grease.

Christie,

Thank you for the response.  It is surprising that a PT is the first to respond.  I would have expected a PTA to be the first.  

I have a Masters in Psychology and a Bachelors in Early Childhood Education and with 13 years as a PTA I don't think more science and psych classes will make me a better physical therapist.

I appreciate your support for more bridge programs.  Did you tell the APTA this and what was their response?

A sick in to prove to the APTA we need more bridge programs? Some how this doesn't make sense.  All you will be doing is showing your peers that we still need PTAs...not bridge them to PTs.  

I support the promotion of more PTA bridge programs...if RNs can progress from an associates to a BSN, to a MSN on a part time basis, then it stands to reason that there needs to be a transition for a PTA as well.  However, what needs to be developed is the intermediary step between PTA and PT.  This is where PTAs need to get creative and provide input to the APTA.  Perhaps a PTA who can perform reassessments or discharge summaries but not initial evaluations or direct access?  Just an idea.  My point being is, there needs to be a more obtainable short range goal for PTAs...a BS degree with a firmer ground in some of the core sciences...more bio, psych, statistics...something that gives a reason for a PTA to get a BS degree, but that still progresses them to the PT degree.  Then yes, a PTA will have a firmer basis on which to enter a PT degree.

Should there be a modified online course? Sure, if we are already exploring entry level PT programs with modified online schedules (see University of St. Augustine), then it stands to reason we can create a PTA bridge program as well.  

...but a sick in isn't the answer and coveys the wrong message about a practicioner who is trying to INCREASE their level of professionalism.