A Specialist in the Silo

Christie,

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.

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."