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PT and the Greater Good

Defining the Fight

Published June 1, 2010 10:23 AM by Dean Metz

"The fault, dear Brutus, is not in our stars, but in ourselves."

As of late there once again has been much passionate discussion on these blogs about the importance of the DPT and how those of us who elect not to acquire it are actually holding the profession back. This got me to thinking. I don't need a doctor's referral to treat here in the UK. I work almost completely autonomously. I have no concerns about reimbursement; I'm on a salary for the NHS. My feedback is valued by nurses, general practitioners and patients. If I wanted to open my own office, I could do so, but people would have to pay out of pocket for my treatments. I am essentially working in a way that is proposed by the APTA vision 2020.

I have only a bachelor's degree, as do most of the physiotherapists here. Now I wonder, if I can practice this way here, why on earth would I (or should I) pursue a DPT? Why can I do the things here that still seem such a long way away in the United States? Are we, as a profession, heading in a very misguided direction? What if we discover our vision is simply an illusion?

It is the difference in the systems. The doctors here are not afraid of a loss of income as a result of my working with someone. They are not threatened financially by my work. They, like myself, are on salary with the NHS. The APTA and many people who post on this forum seem to believe that once all PTs have a DPT then the medical world will wake up, realize our value and welcome us into the fold with open arms. We will have proved ourselves worthy.

It is not going to happen like that. At that point, the fight will really begin because we will be an even bigger threat to the AMA and the prospective incomes of MDs. Doctors want to be the gatekeepers so they will always be necessary. They are not going to watch yet another bit of their income slip away without a fight. I've worked in Florida, which has had direct access for a while. It doesn't make a bit of difference in the way one practices there. The insurance companies and Medicare still insist on an MD referral in order to get reimbursed for treatment provided.

As long as the United States has a health care system based on insurance reimbursement, the doctors will be the gatekeepers and we will be subservient to them. That will not change until the APTA has a stronger lobby than the AMA, which is very unlikely. I applaud those who have endeavored to acquire a DPT. You have demonstrated your aptitude to the profession, built up your skill sets and are starting at a place of greater knowledge than those of us who began with bachelor's degrees. However, you must realize that this is not the be all and end all of your fight for recognition. It is not, and I think never has been, a fight about competence; it is a fight for financial control.


Couldn't agree more. The problem IS the healthcare system here.  More degrees probably won't change that.

Katesel strimbeck June 6, 2010 7:34 PM


As always, an interesting perspective you offer.  (My six year old has been enjoying the Star Wars marathons airing here)

There is a political element to healthcare that can't be wished away.  Finances and egos play into this considerably.  

I don't know that the AMA will ever have to worry about going toe-to-toe with the APTA; the DPT seems to be eroding the most powerful weapon any group can have:  unity.  Without that, we will weaken from within.  A house divided...  

Janey Goude June 1, 2010 7:27 PM

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About this Blog

    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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