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Eating my words . . .
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Eating my words . . . - November 5, 2002 11:26:00 AM
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Andrew M. Ball PT PhD
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Joined: July 28, 2002
From: Charlotte, NC
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Forum,
Funny story - - - I pulled my upper back today, recurring injury that I sometimes see a physical therapist friend for, while working with a kid that I treat. Although I have a few BSPT, MPT, and DPT friends in the area, all of them are so busy that I'd feel unprofessional just walking in (especially given the dress-down rif-raff way that I happen to be dressed today --- some of the homes I go into require resolving to destruction of clothes). The only other option in the area, was to see a chiropractor.
Skeptical, yes, but I nevertheless stopped at a chiropractic office for a lunchtime "quickie" instead. Turns out what he did, other than the x-rays and manipulation, was in virtually idential detail (save a less extensive interview than what a DPT would tend to) to how I'd have been examined and evaluated by an outpatient ortho PT. This guy happened to be a "mixer" and supplimented his adjustment with a home program --- complete with cervical McKenzie exercises. I have to admit that it pinched a bit to realize how easy it was to walk in to see a DC how McKenzie was lifted without credit to physical therapy. My heart dropped to realize how nearly impossible it would have been to stop in and see any of my PT friends in the area and how easy it was to see the DC. Hats off to DC’s superior organizational management and marketing. I'm hated by most DC's and could walk right in, and --- well --- okay --- as far as other PT's and I are concerned opinions vary. The point is that had I wanted to see a PT, I would have had to have made an appointment for a few days from now, and I was in pain RIGHT NOW! The DC office could deal with that, and I'd feel unprofessional even suggesting to a busy PT clinic that I needed to be seen today. How many patients are made to feel the same way????? Are we marketing OURSELVES as PT's out of patients by poor organizational management in this regard?
Anyway, we chatted a bit and I didn't tell him who I was or what I did at first, but we made fun of Sid Williams (the former Life University wacko president squarely responsible for Life's loss of accreditation) for a bit, trashed AK, and snorted at strain-counterstrain and craniosacral therapy. Okay, I thought, his head is in a normal place even if he may be doing some functional rehabilitation in ways that I may find not appropriate --- but I'm in pain so we'll overlook that for now.
Finally he asked me who I was and what I really did for a living (I orignally told him that I had an MBA and Ph.D., and was in public policy administration. True, but not the whole true). The good news was that he's not been on the ChiroWeb webiste for a while and hasn't seen the way that've trashed Life and every Life graduate I've ever met over the course of the past few months --- a good thing considering this guy turned out to be a 1996 Life graduate.
SOOOOOO. Given how evidence-based this guy appears to be, and given the fact that he's a recent Life graduate and in many ways a kindered spirit in chiropractic in terms of my own professional philosophies --- it would appear that I've got some crow to eat (pass the hot sauce). Unfortunately for Life, guys like him, in my experience, are the pleasant exception.
Dr. Drew
[This message has been edited by Andrew M. Ball PT PhD (edited November 05, 2002).]
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Re: Eating my words . . . - November 6, 2002 4:10:00 AM
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PTupdate.com
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Joined: October 8, 2001
From: Pittsburgh, PA USA
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Drew,
Your experience is not that all unexpected. Chiros, as a group, tend to be far more professional and market driven than the PT profession. They have some wonderful professional fund raisers to which our cookie bake sale fundraisers can't even compare.
Even on a day that my clinic sees 90 patients, we will always accomodate someone in pain, as long as they can tweak their own schedule a little bit and come in at a slower time. Most PT's will not do this, as I have found out over the years. Hell, I have seen many PT's make a person sit in the waiting room until their appointed time, even though they really were not busy. It boils down to an ego and power thing, in my opinion.
A few years ago, the girl from a local physicians office had severe neck pain and was referred to PT. We were not a complete "in network" facility for her insurance, so she tried the place that was. They would not get her in for over 10 days, and I KNOW this clinic doesn't see any significant volume. She called me and was willing to pay the out of network fees to get treated. Who do you thing saw most of that offices patients from that day on?
Drew, you know my opinion on the professional and personal practices of most PT's. I don't worry about offending anyone reading this, because anyone sitting on their computer checking out this site or any other PT site doesn't fit this mould (or mold as I like to phrase it!)
Duffy [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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Re: Eating my words . . . - November 6, 2002 12:31:00 PM
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Andrew M. Ball PT PhD
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Joined: July 28, 2002
From: Charlotte, NC
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Sure I was curious, but I've been to a chiropractor before --- in fact I've spent time taking courses in chiropractic school once upon a time. Perhpas it's not generalizable to the lay public and I was simply rationalizing the fact that I didn't want a colleague to seem me without shirt and tie while I was on the clock or acting in some otherwise professional manner.
The point is nevertheless the same. Walking in off the street, I felt more comfortable that I wouldn't be dissrupting the day within a chiropractic office, than within the office of a PT colleague. My other half is working at the APTA clinic of the year, Jack D. Close and Associates, and she said the same thing --- they would have worked in a walk-in off the street. I just felt that it would be unprofessional of me to impose myself in that way.
How many of the lay public assume the same thing? How many assume that they'd have to make an appointment with a PT, but that they could walk in to a chiropractor's office in the healthcare analogy of "The Hair Cuttery?"
How does that perception affect the patient flow to physical therapy vesus chiropractic clinics?
Forgive the spelling errors please, I'm in a rush and don't have time to spellcheck.
Drew
[This message has been edited by Andrew M. Ball PT PhD (edited November 06, 2002).]
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Re: Eating my words . . . - November 6, 2002 1:52:00 PM
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OSUPT
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Interesting points, all of you. I do think PTs are at a disadvantage compared to chiropractors, LMTs, etc. in that not all of us have direct access yet. To see a PT in non-direct access states requires a visit to the doctor first, which automatically makes us less convenient than other healthcare professionals (even if the patient can be seen on a walk-in basis on the same day). Don't get me wrong; I think we could definitely learn a thing or two about business from our chiropractic colleagues. However, until we are recognized (legally and through public knowledge) as a portal of entry into the healthcare system, it's tough to compare the two.
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Re: Eating my words . . . - November 6, 2002 2:16:00 PM
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flexion
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I agree that PT and DC in terms of walk-ins is tough to compare as DC is direct access all over and PT can require an MD involvement. Of course that MD referral instills quite a bit of confidence and compliance to the PT which DCs don't get.
Here in Canada, for example, DCs can treat workers comp off the street but PTs must have a referral from an MD or DC so that lag time obviously affects a PTs ability to deliver timely acute care.
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Re: Eating my words . . . - November 6, 2002 3:42:00 PM
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Andrew M. Ball PT PhD
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From: Charlotte, NC
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What does it say to ya'll that I'm in a direct-access state but walked into a DC office anyhow due to, in my mind, a different attitude of the healthcare provider toward the walk in?
My back hurts again --- got to do my exercises, the ones the DC gave me don't do a darned thing, so I think I'll fall back on my physical therapy expertise --- even though my expertise (though emerging in outpatient ortho) is pediatrics.
Drew
Drew
[This message has been edited by Andrew M. Ball PT PhD (edited November 06, 2002).]
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Re: Eating my words . . . - November 6, 2002 5:38:00 PM
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Sebastian Asselbergs
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Dr.Drew: Hope you'll feel better soon!
In Ontario we have direct access. PT clinics can get as many walk-ins as chiros - those PTs who do see them, have spent time and effort to market and educate the public. Word-of-mouth is a huge help here: after 16 years in this community, it is common to have people just walk-in, or send in by coach when in great need. As SJ states, it can kick life into a day!
But generally Dr. Drew, our profession does not spend time and effort at the university level to teach the PTs-to-be how to market. There is a little bit "we do not want to be as gauche as the chiros" - "we are more professional by marketing less" (statements made by eminent colleagues of mine at the university). My take is that it should be taught, and then the individual PT can decide whether it fits him/her to use the skill. There is bit too much emphasis on "we should NOT be like chiros!!" at the association levels. We can be discerning and we can learn from their approach - good and bad. The Rotary Clubs here have a few chiros per club - I am the only Rotary-PT in this town.
Don't get me wrong, I did not become a Rotarian to get business, but when I saw the effect exposure to many influential people had on my practice (just by chatting - not marketing), I realised how much it will have helped their professional exposure!
Sebastian
(and please consider getting involved in Rotary- great work to be involved in! My .05 plug)
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Re: Eating my words . . . - November 7, 2002 6:16:00 PM
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goodlooks58
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To: Dr. Drew: First of all DCs and PTs are different as apples and oranges. Their paths will never meet as the bottom line is money! I am from Calif. I am from a small town and in private practise since last 18 years. I know many DCs in my area and their style of practise. Every DC does e-stim as it reimburses more. Evry DC does modalities and legally within their scope they can have unlimited aides, massage therapists etc. Therefore if I walk from the street to see a DC, I can be seen right away as there are numerous helpers available. The other aspect to my above statement is population: DC are way more in numbers then PTs. Like in every society whenever there is population explosion there is going to be unethical and illegal activities as survival becomes a problem. So that is why DCs have to come up with gimmicks like nutrition/supplements, AK, pediatric manipulation in the guise of Family Pracitce chiropractor. Also in a large DC population every one cannot be just cracking backs so they explore other avenues of making money. PTs have major restrictions: (1) Cannot have more then one aide to a PT (2) dependence on referrals rather then coming from the street. Eventhough CA is a direct access state, I still have to depend on MD referral as the Insurance companies will find every justifiction in the book for
denying reimbursement. (3) PTs were never educated to sell their services. Like most new grads when I came out as a new hotshot PT I thought that I can just open up a shop and patients will come. I was wrong. Even to this day if I have to sell Foam Rollers or Therabands to my patients I have a great difficulty. So Drew with all your warm fuzzy feelings towards DCs and negative feeling towrads fellow PTs, PTs in general still run ethical and moral practices!
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Re: Eating my words . . . - November 7, 2002 7:05:00 PM
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flexion
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SJ, I hear you about this new walk-in animal that has been appearing. I've set a policy in my office where new patient walk-ins aren't seen on the same day irrespective of my schedule. Patients of mine, I make an effort to accomodate them.
I find when you accept a walk-in of this nature then the patient has just set the tone for the way your office works and they expect to get in on their terms. I've found that these walk-ins appear and disappear just as fast, expect instant results and are usually the money complainers as well.
So, I do lose these walkins to probably someone down the street as most of them won't wait a day to see me; but, I would never expect to call a professional and get in that day - except say a hospital for an emergency.
I wonder, does everyone treat the patient on the first visit or hold off? I've moved away from the first visit treatment and I find compliance and respect for the treatment I provide has gone up.
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Re: Eating my words . . . - November 8, 2002 3:28:00 AM
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Andrew M. Ball PT PhD
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From: Charlotte, NC
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GL,
Let's not go putting words in my mouth. I'm not "warm and fuzzy" toward chiropractors, and I have the same concerns about their professional looting as you do. Check out the "Chiropractic Maddness" thread before charging me as anti-physical therapy and pro-chiropractic. Your statement is not only wrong. It's insulting.
Despite my concerns about chiropractic turf poachers, I have equal concerns about PT's who limit themselves and their operations to what insurance companies will pay. That's missing the point. If a patient needs glasses, they go to an OD --- doesn't matter to them if insurance will pay or not. If they have a cavity they'll go to a DDS --- doesn't matter to them if insurance will pay or not. Physical therapists are a lot of great things, but we're not what the public thinks of as a portal of entry provider for any specific ailment. That's not insurance's fault --- that's our fault.
What is it that physical therapists, many of whom are now graduating with, or transitioning to clinical doctorate level in their own right, offering patients that they’d be willing to pay out of pocket for en masse? I’m sure some of you have patients that would, but that’s not the norm. Until we can fill in the blanks of the healthcare Mad Lib, “If a patient needs ______ they’ll go to a DPT,” we’re not ever going to truly evolve into the primary care practitioner that new graduates --- MPT or DPT, are being trained to be.
The evil, in my opinion, isn’t insurance companies --- it’s accepting assignment. When a physical therapist accepts assignment, they limit their abilities to charge the patient out-of-pocket. There are of course survival reasons that many PT’s decide to accept assignment, but that all goes back to inability to fill in the Mad Lib and professional fear that the public doesn’t respect our knowledge to pay out of pocket in enough numbers that would allow for us to feed our respective families. PT's are a lot of great things, but as a group, risk-taking entreprenurials we are not, and I for one am getting a little tired of whining therapists who continue to self-erode their scope of activity, and by extension, the scope of practice of all physical therapists, on the basis of what insurance is willing to pay.
We shouldn’t blame the insurance companies. We shouldn’t blame our profession. We shouldn’t blame the APTA that has done a rather effective job fighting for and preserving the livelihood of those wanting to work squarely under the Medicare umbrella accepting assignment. We shouldn’t blame anyone but ourselves as individual clinicians. We did this to ourselves.
Drew
P.S. Before SJ goes off on a rant here, I use the DPT designator intentionally. The public, right or wrong, often sees physical therapist on par with massage therapists and athletic trainers while seeing DPT’s on par with DDS, OD, and other non-medical clinical doctors. We need to use this perception to better market to the public. Those of you trashing the value of the DPT over your degree in public forum are only cutting off your nose to spite your face in that respect.
[This message has been edited by Andrew M. Ball PT PhD (edited November 08, 2002).]
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Re: Eating my words . . . - November 8, 2002 1:57:00 PM
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flexion
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SJ, ya I agree that the case where the MD tells the patient to come down I bend over backwards to get them in... when an MD sends the patient compliance goes way up just from the referral. I was more talking about those walkins that just are driving by or some other stupid reason.. LOL
Drew, being outside of the physiotherapy profession I personally look at the letters DPT with less respect than PT. It confuses me if nothing else. I'm a technician just as much as a PT is and no matter what letters you stick by your name you still are going to be considered less than an MD, DDS, or OD because you can't prescribe or do surgery.
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Re: Eating my words . . . - November 8, 2002 2:30:00 PM
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Andrew M. Ball PT PhD
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From: Charlotte, NC
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SJ,
I do in fact volunter one day a week in exactly the kind of clinic you describe. You are correct in it being illegal to charge certain patients one fee if they have insurance, and other patients another fee if they don't --- but unless something's changed since I last looked, that only applies if you accept assignment. If you don't, you're free to charge on a sliding fee scale provided that your sliding process is universally applied in a fair, equitable, and systematic manner.
You apparently agree with my primary point of we'd all be better off it we all divorced ourselves from insurance, but that once again gets back the the primary problem of our profession --- inability to fill in the Mad Lib.
Flexion,
Although DC's have a complex in terms of comparing themselves to MD's and DO's, with comical delusion that self-annointing themselves "chiropractic physician" means that it's only a matter of time until they're considered equals, or at least primary care physicians.
DPT's don's see themselves that way. A DPT wants only to be a primary care, portal of entry practitioner for neurmusculoskeltal problems --- screening out surgical from non-surgical clients, referring on when appropriate and treating through exercise, orthotic, and manipulative/manual medicine without anyone else's input when and as appropriate.
A DPT is a clinical doctor, not unlike a PharmD, PsyD, or OD. OD's by the way, can't do surgery and have only limited perscription rights --- exactly where the DPT is headed.
Finally, last time I checked, DC's can't dispense drugs nor conduct surgery either --- does that mean that I should re-assess the level of respect that I afford them? By your reasoning they should not only not be considered a physician, they shouldn't be called doctor.
I disagree.
I believe that both DC's and DPT's (but not necessarily BSPT's or MPT's), are well educated to function as portal-of-entry, primary care practitioners for NMS conditions while accepting full legal responsiblity for screeing out and differentially diagnosing medical conditions.
Drew
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Re: Eating my words . . . - November 9, 2002 5:22:00 AM
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flexion
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Drew, I understand where DPT wants to go and hats off to your profession if you can do it. I heard the same primary care, portal of entry stuff while in school and they trained us that way as well with all the Dx, imaging, blood work, Tx etc to be primary care.
I seriously doubt the public will look at a DPT as a primary care clinical doctor for quite some time. The people that represent and protect the public via licensing have a DPT and PT write the same licensing exam - is this correct???
You can re-assess away about where a DC fits in. Its not like a DPT is going to refer to a DC or a PT anyway. A DC and PT is pretty much a peer in my mind. "Doctor" or "physician" are just words based on legislation - in Canada its based on ability to convey a Dx.
The public looks at their family doctor as their gatekeeper - they have all government, insurance and drug companies on their side. They like to be in control of what is happening and again good luck to you if you think you can just bypass the MD and send the them on your terms. They'd really love that... LOL
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Re: Eating my words . . . - November 9, 2002 7:43:00 AM
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Andrew M. Ball PT PhD
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From: Charlotte, NC
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Flexion,
The problem with chiropractors, speaking from my extensive interviews of them for the purposes of my dissertation, is that they don't see a difference between "portal of entry primary care practitioner," and primary care physician. DC's, like DPT's are in a handful of DC schools, adequately trained to be PCpractitioners operating under direct supervision of an MD specialist. They delude themselves into thinking that means that they're trained to be primary care physicians. Self-proclaiming oneself to be a "chiropractic physician" doesn't change that.
I could call myself a "Physiotherapeutic Physician," your eye doctor an "Optometric Physician," and heck, your car mechanic an "automotive physician." It doesn't make any of them qualified to be primary care physicians. Primary care practitioner, under the umbrella of a specialist MD --- that's a different story. Why chiropractors feel that they're somehow special among non-medical clinical doctors is beyond me. To all other providers of care, it's a comical sidenote recognized only as a punchline, and dismissed just as quickly.
As for DPT's, I'm not suggesting competition with MD's. Your perceptions in that regard may be a little tainted by your chiropractic degree, training, and (if you're anything like most Life graduates) brainwashing, in that respect of being an eventual PCP.
What I suggest is something like a collaborative realtionship between MD's and DPT's in the same orthopedic or neurology clinic, where the DPT operates much like an OD does in an opthamology clinic. The benefit to the physician is obvious --- a DPT becomes a physician extender for the MD, with better neuromusculoskeletal knowledge than the RN's, PA's, and NP's that are currently used. There is also a marketing advantage for a practice to use all clinical doctors, as opposed to nurses and technicians.
By being within mainstream healthcare, DPT's have the ability to make that happen. Chiropractors, by contrast, may have nearly equal knowledge in that regard, but most are are too far on the fringe, more than willing to operate outside the scope of evidence-based care, and will therefore never be accepted at the same level as a DPT by orthopedic or neurosurgeons.
DC's therefore, must sadly continue to market on the basis of, "someday the public will view us at the same level as an MD." They don't have much other choice if they're to survive as a profession. To those DC's, who belive the "placebo" of that statement, I say keep dreaming.
In the very near future, DPT's and DC's won't be peers, at least not in that respect, because MD's will welcome DPT's into that kind of practice model without hesitation while DC's will, in general, not be considered.
Drew
[This message has been edited by Andrew M. Ball PT PhD (edited November 09, 2002).]
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Re: Eating my words . . . - November 9, 2002 9:25:00 AM
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rcptmt
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drew
i cannnot keep up with you.......
please tell me your vision for the DPT as opposed to a regular old PT.............
in my opinion, the only benefit of the DPT will be if medicare and other insurance companies allow true direct access....meaning insurance reimbursement for the services of a DPT without the need for a referral from a MD DO........etc
there are already some insurance companies that do not require a referral.........
there is talk with medicare now about true direct access for PT..........this would be at least 5 years in the future and i have not seen any tie in with mandating DPT for this to happen.........perhaps that will be a compromise, HHS/CMS says educate your people on a doctoral level and we will allow true direct access,,,, stay with your current system and we will never allow true direct access ....if that happens i would be first in line for a DPT
and yes i am aware i am hung up on the insurance issue....if you want to be in the mainstream healthcare arena, you are a puppet for the government and the insurance cos and they pay the money so they make the rules .... i dont see how this can be debated.
you also seem to be confident of the respect a DPT will get from the medical profession.....i think in this respect your academic background is clouding your business sense............MDs , DO's etc use PA's and NP's so they can see more patients and bill insurance companies for it, because they fought for it and got it allowed..... they also fought for and got a severly weak stark law that obliterated any of the protection it would have afforded the PT profession when it comes to physican self referral.....So physicians can refer NMS pateints to their own facility AND they can use anybody off the street to perform the services and they can bill insurance cos for it......do you feel that the docs are just waiting for a doctoral trained DPT to show up so they can collaborate with them instead of using the current sytem that already favors them so much.....
you think the orthpoedic surgeons who fought the hardest to weaken the stark laws and are our main source of opposition for true medicare direct access will suddenly view you as more of a peer because you have a DPT? i dont see it happening.
you have written in the past about how physical therapists should be less dependent on insurance reimbrsement.......i agree with you 100%. so when it comes to cash paying customers how does a DPT have the advantage over a PT? the extra academic knowledge and "evidence based practice" commitment could possibly be an advantage in the marketplace.........the competition for NMS patients is intense.........in the cash customer area you have personal trainers, ATCs, LMTs, yoga teachers, accupuncture, etc etc.....thes folks have proven in the past 5-10 years that they are able to attract NMS cash customers, (and we as PTs sit back and bitch about encroachment on our turf)....
some PTs have recognized this and are building cash based practices... again what advantage do you see A DPT offering the cash customer over a PT? do you think the same public that is willing to spend their $$$ on a non college educated LMT or yoga teacher will care about your doctoral degree?
anyway......no disrespect or anything,,,, again i think the DPT could be good, but im not sold on it yet........
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Re: Eating my words . . . - November 9, 2002 9:49:00 AM
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flexion
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Drew this clouded "primary care" that you hear DCs talking about... where?
You yourself are calling a DPT primary care for NMS which is misleading. The term I was taught to use in school years ago was primary contact. Primary contact means that someone can walk-in off the street and see me without a referral. In the past, before my time, DCs used to say primary care meaning primary contact (ie. portal); but, it was confusing because primary care really means you can do everything for the patient so they changed the wording.
In Canada, that is the term that is used. A DPT is NOT a primary care anything... they are primary contact just like a DC. And you should tell your association to stop using primary care as it will annoy all the MDs as it did for our profession 'till we changed the wording.
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Re: Eating my words . . . - November 9, 2002 11:14:00 AM
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Andrew M. Ball PT PhD
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From: Charlotte, NC
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RcPTmt and Flexion,
Primary care physician was chanted by all but two or three of the chiropractors I interviewed for my Ph.D. To be fair, however, most were wacky Life graduates brainwashed by Sid Williams.
My Ph.D. is in business administration/healthcare management --- so I doubt that my vision is clouded on the subject by being in academics. I suppose that it would surprise you to know that in addition to teaching, I work a full time pediatric job, and volunteer once a week in a busy outpatient ortho clinic to "keep it real" in terms of both application of management into the "real world" as well as keep my ortho skills from rusting over. We simply have a slight difference of opinion between us, RcPTmt.
Flexion may have a point with use of the term "primary contact," but this is not all that being a primary care practitioner might mean for a DPT. In some cases, for example, a DPT might have a patient delegated/referred to them, just like as is current --- but with increased knowledge of differential medical diagnosis and screening with respect to your average BSPT, the MD can rest assured of a higher level of diagnostic skill on the part of the DPT than your average PT. Sure there are BSPT's who have more skill in differential diagnosis than others as a function of experience, but usually skills are limited to red-flag recognition only, and as such PT's don't really have any legal resonsiblity to catch anything missed by the physician. I belive that with the DPT, that will change.
The other problem with "primary contact" as a term of use, is that it does not reflect the fact that as a primary care practitioner, the physical therapist often is delegated the complete care of the patient for a period of time during the rehabilitation process. As a recognized primary care practitioner, the DPT will be more responsible than current, for the diagnosis, care coordination, and management of medical care in between medical physican vists.
Drew
[This message has been edited by Andrew M. Ball PT PhD (edited November 09, 2002).]
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