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PT's prescribing medications
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PT's prescribing medications - August 4, 2005 7:36:00 AM
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vt2c1ms
Posts: 74
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From: Kansas
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What's everyones opinion on the future of PT's prescribing medications in the civilian world? Think it will ever happen--in our lifetime anyway?
Mark
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Re: PT's prescribing medications - August 4, 2005 7:55:00 AM
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Sean Weatherston
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From: Idaho
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I've always thought it would be nice to have the same privileges/responsibilities as the military PT's have. I look at Alex and Jason in here for example and think they're pretty sharp therapists who have the background to prescribe.
Of course, I don't think we need to be prescribing Viagra :) and with the brouhaha involving the new COX-2 anti inflammatories being safe or not...maybe having someone else get sued isn't bad.
Anyone have any details on how much pharmacology background PA's and FNP's have before they get prescription privileges?
Sean, PT, OCS
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Sean Weatherston, PT, OCS, CSCS
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Re: PT's prescribing medications - August 4, 2005 8:05:00 AM
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steve
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From: Canada
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Count me out - significant increase in liability. I'd rather continue to focus my educational pursuits in orthopaedic manual care and work in conjunction with physicians to provide patients optimal care.
Steve
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Re: PT's prescribing medications - August 4, 2005 8:11:00 AM
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truthseeker
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Personally, I don't like the idea of PTs prescribing meds. there are too many possible interactions between meds and our training is not adequate. Further, since I work in a primarily outpatient environment, I don't have access to complete medical history as compliled by the patient's doctor so I am dependent upon the patient's own recollections. Often they do not know the names or properties of their medications.
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Re: PT's prescribing medications - August 4, 2005 8:20:00 AM
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paulpt
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The idea that PTs could prescribe will create a new type of patient for the outpatient PT, the pain medication seeker. It is doubtful if the rank and file PT has the background to manage any prescriptions, let alone those which are frquently abused nd easier to seek.
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Re: PT's prescribing medications - August 4, 2005 9:04:00 AM
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Sebastian Asselbergs
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From: Barrie, Canada
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I'm against. Would require sunch an incredible change in most educational programmes - re: patho, pharm etc - not realistic. And yes, dangerous with too many prescribing sources...
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Mundi vult decipi
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Re: PT's prescribing medications - August 4, 2005 11:23:00 AM
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karmzack
Posts: 181
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From: Hawaii
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You scardy cats :).
The privileges for a military PT to prescribe medications depends on the hospital/clinic that they work at. For the most part the medication that we are allowed to prescribe are limited to stronger-than-OTC NSAIDS, acetaminophen, and a few muscle relaxers. This privilege really helps out when we are in the physician extender role with direct access. If I’m just working in my clinic I rarely will need to prescribe anything because that aspect was already taken care of by their PCM. I think it would be a natural progression as civilian PTs gain more autonomy. Having said that, my typical patient is 20-28 y/o, M, and (most times) is in good general health. If you are working with a geriatric population it may be a different story.
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Zack Solomon MPT, OCS, CSCS
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Re: PT's prescribing medications - August 4, 2005 11:54:00 AM
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Sebastian Asselbergs
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Working with people with multiple pathologies is going to be much more common than it is already - at least here in civilian land. Diabetes, RA, cardiovascular pulmonary issues are all already a present in many patients - and will only get worse with time and our aging population.
If it's only for some NSAIDS and muscle relaxants - a phone call to the MD or his nurse (5 minutes), and a good relationship is all one needs. I understand your position in your particular environment - IMO, it doesn't really apply in general populations.
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Mundi vult decipi
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Re: PT's prescribing medications - August 4, 2005 12:14:00 PM
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Dr.Wagner
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Coming from both backgrounds, it really takes more training and understanding to prescribe, it will not only be the BRIGHT PTs that would prescribe, but those at the bottom of your class. I have always felt strongly that if one has the capability to prescribe, then one needs to have an intimate knowledge of what to do for overdoses and acute treatment...
My biggest problems with "muscle relaxers" is that there really is no such entity. They are all depressants/relaxants with systemic properties (ie Flexaril is no more effective than valium...so do you wish to prescribe valium?) they also have street values.
I know I for one have found that when people realize you "hold the key" to a quick high, you become used and abused by the public.
The civilian population is not a fair comparison to the military.
PS. Why would you want the additional malpractic premiums or liability?
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: PT's prescribing medications - August 4, 2005 12:33:00 PM
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karmzack
Posts: 181
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From: Hawaii
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I posted a poll on this topic just to have a little fun with it. Play along!
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Zack Solomon MPT, OCS, CSCS
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Re: PT's prescribing medications - August 4, 2005 12:40:00 PM
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Sean Weatherston
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From: Idaho
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Wags, excellent point about the OD and acute treatment.
Also agreed on how relatively easy it is to get something for our patients if we think they need it....a quick call to a doc usually gets the job done.
Sean, PT, OCS
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Sean Weatherston, PT, OCS, CSCS
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Re: PT's prescribing medications - August 4, 2005 2:05:00 PM
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jma
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From: NY
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I agree with Dr. Wagner on this one.
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Re: PT's prescribing medications - August 4, 2005 2:37:00 PM
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vt2c1ms
Posts: 74
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From: Kansas
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If I wanted to Rx meds, would of went to med school. PT's salary after paying insurance premiums would be about $25,000 / year at the rate they are getting paid now. I vote hell no!!!!!! Let the MD's/DO's do the medicines.
Mark
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Re: PT's prescribing medications - August 4, 2005 3:32:00 PM
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SJBird55
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From: Michigan
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I've never understood how physicians do it with knowing all the prescription stuff. Family practitioners are seeing a higher population of less healthy individuals with multiple comorbidities... new medications seem to always be coming into the picture... knowing the interactions between medications.... knowing which insurance company allowed what... and thinking about the risk/benefits to rationalize the use of a medication. Me and my memorization skills would get me prescribing some medication that sounded like another one... I'd spend more time looking medications up and getting it in my thick skull which medication was used for what... I'd probably be a liability.
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Re: PT's prescribing medications - August 4, 2005 3:41:00 PM
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vt2c1ms
Posts: 74
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From: Kansas
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Honestly,
I doubt MD's/DO's know all the prescription stuff. They know more than anybody else, but it's impossible to know all the interactions--co-interactions in the human body, especially when it changes from individual to individual. Not trying to downgrade knowledge, but just saying it's impossible to know all that stuff. Most probably prescribe off what type of dinners are offered from the pharm. reps. :) Just kidding!
Mark
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Re: PT's prescribing medications - August 4, 2005 3:56:00 PM
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Andrew M. Ball PT PhD
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From: Charlotte, NC
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I agree with Dr. Wagner on this one too. The DPT IS NOT intended to be a replacement for a medical physician . . . despite the confusion about the intent of the DPT among MD's, DC's, and even about 50% of new-grad entry-level DPT's. Why on Earth would we want to have the rights to prescribe so as to treat at the pathology level when we are striving as a profession the claim sole expertise of neuromusculoskeletal/movement-pathology diagnosis and treatment at the IMPARIMENT level?
Not only is it counter-visionary, it fuels the existing confusion about what we as a profession intend for the DPT to be.
Not to mention skyrocketing malpractice without comparable take-home pay . . .
The battle to be fought is direct reimbursement. If DC's have it, why don't DPT's? Our DPT's are trained within places like USC, Duke, and Harvard. Like all other clinical doctors, they are trained to recognize what they can safely treat within their own scope and what MUST be referred out to a medical physician. Frankly, I think that the fear is that a DPT will be like the DC who doesn't send out their patient and then claims no responsiblity when the low back pain that their patient had turns out to be a kidney infection or tumor that if caught earlier, could have been more effectively treated. A fair argument to be sure, but because of the comparable training in diagnostics, but the lack of full scope of diagnostic tools within the DPT's practice act --- the likelihood is an OVER-REFERAL of patients, not an under-referral.
What I don't get is why more MD's aren't FOR direct-access and reimbursement for DPT's, as it would increase THEIR referals while at the same time helping to screen out the non-surgical cases . . . leaving them more time to spend in the OR where the REAL money is made.
Finally, "Most probably prescribe off what type of dinners are offered from the pharm. reps" is, according the the study published in either JAMA, BMJ, or NEJM last year, less of a joke than the public might be comfortable with . . .
Drew
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: PT's prescribing medications - August 4, 2005 5:09:00 PM
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tc
Posts: 137
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From: Los Angeles area
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"Anyone have any details on how much pharmacology background PA's and FNP's have before they get prescription privileges?"
Sean,
This is my only experience with this question.
My friend went through the master's in PA program at Midwestern and they had an intense course in pharmacology. Additionally, she was required to use that knowledge on all of the clinical rotations and it is definately covered on their board exam. However, I do know that after being in practice awhile, she still spends a LOT of time trying to keep up with all the new drugs, especially with all the commercials touting all the new ones on the market.
Personally, I don't want prescribing as part of my practice act, for many reasons, primarily the liability factor.
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Re: PT's prescribing medications - August 4, 2005 5:54:00 PM
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dragonfire
Posts: 61
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From: usa
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Agree with Dr. Wags. I'd rather not prescribe, there is already so much to learn in the field that to add the responsibility of prescribing is way too much to handle for me.
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Re: PT's prescribing medications - August 4, 2005 5:57:00 PM
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vt2c1ms
Posts: 74
Joined: May 9, 2005
From: Kansas
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I don't think PA's can Rx medications unless there is an MD/DO stamp on it. I do believe they must have MD/DO approval. I know OD's can Rx meds here in KS, passed a couple years ago--painkillers, etc. What is the exact difference between a PA and a nurse anyway? Is it just to support the rural areas where there are shortages of PCP's (why can't a nurse do that?) or is it just to further elevate the "physician"? Just curious. I do here PA programs are pretty tough and challenging to get into.
PT's better get a spike in pay before they start Rx'ing meds to pay for that insurance, or else practicing PT's will be in for one.
Mark
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Re: PT's prescribing medications - August 4, 2005 6:05:00 PM
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tucker
Posts: 182
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From: Texas
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I am also against prescribing medications, but I do believe it would be beneficial to be able to prescribe DME...After all that is our area of expertise. I personally can't stand having to wait for a physican to write/sign a prescription for a specialized wheelchair, walkers, or an AFO...heck, most of the time, they have no idea what AFO stands for..Typically, we write it and they sign it.
Anyone against prescriptive power for DME?
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