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PTA Blog Talk

A Specialist in the Silo

Published March 18, 2010 2:49 PM by Jason Marketti
Will the therapy profession eventually turn into a series of specialists with doctorate degrees who have been so focused on research, school and administrative duties that they eventually lose touch with the patients they were initially committed to help?

This may happen with the current trend in which we all carry certificates from various schools of thought and continue to attain higher levels of education.  The medical profession as a whole has been going that route for years, deciding unwittingly that with more training they can help more people.  And hospitalists in physical therapy should be right around the corner. 

With more training, there is an increase of knowledge and a better focus to assist patients. Yes? Maybe. 

Eventually patients will see their general PT who can then refer them to the specialist PT who deals only with the shoulder. Is it possible?

Then patients can question why they have to go from one PT to the next just to strengthen their rhomboids.  And eventually it will be thought that we should have more generalist PTs and PTAs in the field of physical therapy who can "do it all" with lower wait times before an evaluation takes place. 

Specialty certificates have their place as does an increase in education but if we are to enter a field where doctorates are the norm and certificates are expected just to treat patients we should first focus on what the patients want from us. 



Thank you for the comment.  An area that is overlooked is the PT/PTA hospitalist.  They often need to make very quick assessments in ICU, PCU as well as on the general medical floor.  Patients change rapidly in the hospital and often w/o therapy intervention and assessments patients get worse.

The comment on the rhomboid strengthening is based on why I have to go from my GP to a pain specialist just to get stronger pain medicine for my back.  I have to see two doctors, get two assessments (two co-pays) when the first could have prescribed it easily.  

With patients more informed they will begin to question these things.

Jason Marketti March 27, 2010 9:56 AM

If you truly believe that a specialist PT has nothing more to offer than just to "strengthen rhomboids" then I believe you have a limited understanding of the critical thinking process that is really the difference between what a PT and PTA does.  

The clinical reasoning skills required for an orthopedic problem often differ greatly from a neurological problem.  Weak quadriceps due to a stroke differ from weak quadriceps due to inhibition for someone with knee pain.  They both need to get that quad stronger but one will be attacked with direct strengthening and the other by first negating the factors causing inhibition.  I predict a divide mostly at the ortho/neuro line.   The basis for understanding neurological problems is often different from the basis for understanding ortho problems (with a little bit of carryover between each).   Will the divide eventually get as detailed as you describe?  Maybe, but people will always have their area in which they have more strength...much like orthos tend to be either "knee guys (or gals)" or "back guys."  

To me, there is really no "jack of all trades"...the field is too broad to have a good handle on the entire scope of PT.  One might be able to handle basic problems that don't require much critical thought (and yes, there are often patients who have very straight forward problems that will respond with simple measures), but as the complexity rises, the past experiences one has had should continue to develop the critical reasoning process. Only the "expert" can begin to feedforward in the decision making process as opposed to the feedback process that occurs with someone with limited experience or exposure to complex problems.  I'd suggest reading some of the works by Gail Jensen that truly define the differences from novice to expert practicioner.  

..."Jack of all trades" I call "master of none."

Christie ,,, PT March 22, 2010 8:19 PM

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About this Blog

    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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