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PTs working for Chiros?
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PTs working for Chiros? - February 20, 2005 3:32:00 AM
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aconcors
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From: Northern San Diego County
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I've seen more advertisments for chiros hiring PTs to work for them. Are others seeing that trend? Does anyone have any idea why this trend?
I'm dismayed about the number of PTs working in POPTS but working for a chiro has got me perplexed.
Andy
_____________________________
Andrew L. Concors, PT, MBA, CIE
carmelvalleyphysicaltherapy.com
cptconsulting.net
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Re: PTs working for Chiros? - February 21, 2005 7:35:00 AM
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JLS_PT_OCS
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I would think this is like working for an MD, in that you are an EMPLOYEE of another professional.
Chiro has an advantage over PT in that it has:
-unrestricted direct access
-better marketing and public image
-a clinical doctorate already in place
-no scope of practice issues
I think we can learn a lot from them about how to run a profession, from the business side. I agree that there are negative things going on also, but I just focused on the positive stuff above.
This gives the chiro office some advantages, notably that they can claim legitimately to be providing "Physical Therapy" and reap some good claims for such.
I believe that this happens because many PTs are employee-minded (as opposed to partner-minded), are unaware of the educational requirements for other professionals (so they're unsure how they compare), are mystified by manipulation and think it is really high-skill stuff only special "masters" can do, and may be more comfortable just following orders. How many PTs have we all met like that? We talk all the time about the HUM'ers (hotpack, ultrasound, massage people), so why shouldn't we be surprised when they go work for someone else instead of forming or joining a private practice?
This has to do with the very way we raise and educate physical therapists. It will probably be several generations before this type of thing dies off...before all of them learn to be independent healthcare providers. I think the DPT and such is another way to move in that direction.
Given that the real enemy of direct access and professional independence is some physician groups, not chiros, I find it hard to feel the "betrayal" or "dark side of the force" thing that many therapists feel on the chiro subject.
Good, evidence based practitioners such as Greg Priest are the extremely rare exception to the rule among DCs, and I believe their profession is having a rough time of it lately, with falling enrollment rates by up to 50% and sky high loan defaults. The writing is on the wall for them, I am afraid. I don't have anything against them as a group, but I do not see them as a viable threat to PT accomplishing it's professional goals.
PTs have a better education in many ways:
-science based (the most important)
-well-rounded in terms of tools and areas of expertise
-flexible to fit many practice patterns
I really don't want to start a PT/Chiro war, honestly, so I'll also say if you are a quality practitioner of any stripe, you will never have to worry about employment...
So this type of thing you describe, while mildly vexing to some, fails to completely get my goat.
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: PTs working for Chiros? - February 21, 2005 12:40:00 PM
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aconcors
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From: Northern San Diego County
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It doesn't get my goat either, I just find it perplexing. I've seen ads in the newspaper and have gotten solicitations from headhunters for chiros hiring PTs for their clinics. Just the other day I answered an ad for renting out space in a local clinic and the chiro owner said he wasn't interested in renting to me as he was going to hire a PT in the near future. I figure there must be some reason (financial, no doubt) for the change.
I do find it interestng in this day and age of PT to find PTs still willing to become employees vs independent practitioners. When I got my bachelor's in PT 20+ years ago we were schooled in the employee role, but I thought that things had changed with graduate level education.
I agree that the POPTS that is the real threat to the future and independence of our profession.
_____________________________
Andrew L. Concors, PT, MBA, CIE
carmelvalleyphysicaltherapy.com
cptconsulting.net
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Re: PTs working for Chiros? - February 21, 2005 1:52:00 PM
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chiroortho
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Andy, I think some folks in any profession just prefer to be employees, work 9-5, not have to deal with the gov't paperwork, payroll, workers' comp, hiring/firing/scheduling, etc. I can tell you from personal experience that there are times that I'd like to just throw the paperwork out into the parking lot, and just care for patients. It's not that simple when you have an independent practice. Don't get me wrong, working independently has its rewards as well, but there are two sides to the story.
There's nothing whatsoever wrong with being 'just' an employee, as far as I can tell. I have an excellent example of that working for me, an outstanding DC that just doesn't want to deal with the hassles of practice. He wants to treat patients and go home at the end of the day and forget work. In many ways, I certainly don't blame him, or anyone else that just doesn't have the personality to deal with the 'stuff'.
Maybe if you look at it that way instead of who the employer is, it will help to make it easier to deal with.
Best wishes,
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Greg Priest, DC, DABCO
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Re: PTs working for Chiros? - February 21, 2005 2:37:00 PM
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Dr.Wagner
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The real threat to PT is not chiro owned practices, it isn't POPTP but rather unethical business practices and poor reimbursement.
I don't think a chiro or physician owned practice needs to be considered unethical necessarily. It all depends on the practice structure. I really don't see how it is any different than a hospital owned practice.
I have worked for some independent practices that were about as unethical as it gets...because they would do ANYTHING to compete and to make money. To physicians (primarily surgeons), PT is NOT a big moneymaker, but rather a way to streamline management. Unethical practice is unethical practice regardless of WHO does it.
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: PTs working for Chiros? - February 24, 2005 2:36:00 PM
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TMondale
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From: Newton-Wellelsley Hospital
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This question astounds and frankly infuriates me. I won't even treat a patient if they are being treated by a Chiro. at the same time. I have vigerously counseled colleagues not to get involved in these relationships and would hope that none would. The basic question is what kind of restrictions would there be on a PT's (employee) clinical decission making by their employer? I don't imagine they would care for a PT coming in and practicing their full scope of evaluation and treatments including grade 5 thrust manipulations to the spine and extremities. I wonder when we as PT's are going to accept that if we are doing our job properly there is no other profession that brings as much to the table as we do for patients with pain and dysfunction. Surgeons are able to help only a fraction of the people that we help; just to name one (with regard to LBP). In that vein why would we work for any other profession, that likely views us as some niche adjunct to them. I don't mind working for people, but if there was some restriction of practice that didn't exist in my practice act it wouldn't last long. I wonder how many PT's are trying to hire Chiro's to work for them. Why not if you've got no faith in your own skills.
I've had colleagues talk to me about going to massage school because of the money a massage therapist can make. I tell them are you crazy; put up a shingle and advertise what you as a PT can do. Surely that would be worth a good bit more than massage.
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Re: PTs working for Chiros? - February 24, 2005 3:30:00 PM
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Dr.Wagner
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Just to reply to the above comment...I think there is a great surge in massage therapists primarily because their title points to what they do...massage.
We all know the therapuetic effects of massage, and as a PT I was taught many techniques. But as a whole, there is great controversy on whether or not PTs should be performing "massage" or "myofascial" techniques. So in general the public has no idea of PT 1 performs the same treatments as PT 2. If they go to a massage therapist, the treatment is implied.
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: PTs working for Chiros? - February 24, 2005 3:47:00 PM
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aconcors
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From: Northern San Diego County
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Just to get back to my original point- I am amazed and astounded that my colleagues will still enter into situations, as employees or not, where someone else benefits from their license. I'm dismayed that fellow healthcare professionals, DCs, MDs, and DOs, who look at us as a commodity that can be plugged into a business plan.
Yesterday I got a call from headhunter hiring a PT to for a DC. He told me that the DC had was using a "coach" who gave her all the "protocols" for treatment and all she needed was the PT. Go figure
_____________________________
Andrew L. Concors, PT, MBA, CIE
carmelvalleyphysicaltherapy.com
cptconsulting.net
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Re: PTs working for Chiros? - February 25, 2005 2:17:00 AM
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TMondale
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From: Newton-Wellelsley Hospital
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Good point Andy.
To respond back to "the above comment". There may be many reasons why a massage therapist is able to make a good living. I don't begrudge them that. My point as a practicing PT is that regardless of what we do for our treatments we are PT's and instead of subverting ourselves to others we need to promote ourselves for what we have to offer. It's our fault not anyone elses that we get involved in supporting other professions and don't recognize the power of our knowledge as it compares to others in the arena treating the same types of problems.
Tim
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Re: PTs working for Chiros? - February 25, 2005 2:32:00 AM
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aconcors
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From: Northern San Diego County
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I actually think the massage therapy discussion is another topic entirely. People think of massage therapy, personal training, cosmetic surgery, and nutritional consulting are life enhancing services for which they'll pay cash. They look at PT, skin cancer surgery, nursing services as healthcare which they feel they have a right to. I treated a friend for free the other day for an achilles problem and on leaving the office she said, "that feels great, I think I'll schedule a massage".
_____________________________
Andrew L. Concors, PT, MBA, CIE
carmelvalleyphysicaltherapy.com
cptconsulting.net
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Re: PTs working for Chiros? - February 26, 2005 8:30:00 AM
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bravocosta
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PT's working for Chiro's , hmmmmm....bad idea. Can't figure out why many of us so devalue our skills and abilities. If you can help a client decrease their pain and or disability what is that worth ? We can provide our clients a fishing rod as opposed to handing them a fish 2x per week for 69 weeks and once a week for 4 years thereafter. This point has been made several times before, but many clients think of physical therapy as something that will be painful and entail suffering. Have seen it numerous times in our clinic where the client is put through in my opinion a stupid and somewhat torturous regimen when a more thoughtful and skillfully applied intervention would do the trick. Why do so many of us feel that patients have to be "cranked on", coerced or forced ? Ironically, have seen this approach far more from the females in our clinic who apply this cr*p with a smile on their face.
Massage therapy implies.... a relaxing environment with a pleasant experience free from the risks of unncessary pain and symptoms not made worse. No pictures on the wall of half cut away humans, no white lab coats and ties and all the accoutrements of the medical profession. Does wearing a white labcoat really help you? Patients (hate that word) must love being medicalized and diagnosed, really. Hustled through at four or more per hour with the client half listened to. A previous poster wrote, "Many times I leave the exam room to attend another patient, but thats just the way it is"....great, I'll gladly pay for that. I can do five an hour...hoo hah and flex my biceps. No wonder people are turning to more thoughtful providers outside the "medical model".
Aaahhhh....that'l do for now....cheers...Thomas
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Re: PTs working for Chiros? - February 26, 2005 5:35:00 PM
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OUPT
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I took a job with a chiro owned occ-med clinic a few years ago that sounded better than it could have been.... and it was. I was hired to run the PT clinic downstairs with the plan being to treat about 80% in-house referrals and market for local MD referrals. I was promised the moon with a wide variety of Dx's (60/40 split of spinal/extremity injuries).
Day 1 was an eye opener. I had approximately 30 evals waiting to be scheduled and every one was from a chiro upstairs.... and every one was a spine injury. I had at least 3 patients that morning that were going to chiro 3x/week and PT 3x/week, and had been pain and limitation free for months (and still off work). I made it through to lunch, resigned, and went back to my former employer. Karma finally came around earlier this year.... the chiro owner, his office manager, and the billing manager were all arrested for an unbelievable amount of fraud. The news report stated that it was the largest fraud case ever in California. Let's just say, I've learned my lesson.
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Re: PTs working for Chiros? - February 26, 2005 10:10:00 PM
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Alex Brenner PT MPT OCS
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I wonder if you had changed the thread topic to "PTs working WITH Chiros" if there would have been different responses.
The Army is in the process of placing Chiropractors at different installations across the country. I personally worked with a Chiropractor at one of these Army installations and it actually was a pretty good situation. This particular Chiro was part of the team, he never acted to belittle us or acted superior to us. He was really suprised at how well we were trained at treating and managing musculoskeletal injuries on a primary care level and direct access. He learned from us and I learned some manual spine techniques from him. When he had back pain and wanted it manipulated he came to us. In the Army we certainly are not hurting for referrals so it was nice to have another option in the clinic. This Chiro also took on some of our more complicated spine patients (those who did not get better in the PT clinic) and he did pretty well with them. It was a good experience.
If the situation was right I could see working with Chiros not for them. Some of the situations with Chiros listed above does happen and it is a shame but I dont think they all practice like that. Dr. Greg Priest (chiro ortho) comes to mind in this regard.
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Alex Brenner, PT, MPT, OCS
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Re: PTs working for Chiros? - February 27, 2005 2:56:00 AM
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aconcors
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From: Northern San Diego County
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i think the situation described above is what we would all describe as an ideal colleagial situation. in fact. I think the military model is a good one for using a scarce resource (highly trained and motivated professionals) in the most efficient manner. I have no problem with Chiros as a whole. I presently sublet from one and dated one in my distant single past. I started this thread because of at least 5 different situations where chiros were only looking for a PT for their ability to bill.
In California a recent law has limited the number of DC, PT, and OT visits to 25 each for all injured workers. I imagine the situations I'm encountering have something to do with that.
While I'm on a rant, I also notice that more DCs are advertising as providing Physical Therapy which illegal under California law and many list rehabilitation in the services they provide.
_____________________________
Andrew L. Concors, PT, MBA, CIE
carmelvalleyphysicaltherapy.com
cptconsulting.net
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Re: PTs working for Chiros? - February 27, 2005 12:49:00 PM
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OUPT
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I should add that my office is next door to a chiro office and we have a great relationship. We have a handful of patients that get manipulated and come next door for their exercises right after.... seems to work well. I would agree that working WITH chiros is a potentially rewarding experience, just not FOR them.
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Re: PTs working for Chiros? - February 27, 2005 4:25:00 PM
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VagusX
Posts: 216
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From: Savannah, GA, USA
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Just a quick response to Army
Chiros working in the army and chiros working outside the army work very differently from what I have sean. I worked for a period of time a Ft. Stewart, GA and interacted with some of the chiros over there. The main difference is that the chiros in the army weren't sticking the patient in a hydromassager while applying e-stim and iontophoresis all at the same time before heading to the manipulation table. The one's I talked to were all business, got right to the point and worked well with the PT's upstairs.
I enjoyed my time spent working at the Army hospital. It was a non-competative environment between all the health professionals working there at the hospital, communication was excellent and the patients got what they needed when they needed it. Sometimes i wish I could still be working there, but the space that I was working in (Contracted out to work on Dependents) was needed for a more functional based rehab facility.
And I would have to agree with Dr. Wagner. Chiros and PT in a perfect world work great together. The problem is overutilization and ethics.
Dan
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Re: PTs working for Chiros? - February 27, 2005 5:00:00 PM
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TMondale
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Dan,
I would respectfully disagree with the notion that in a perfect world PT's and Chiros work great together. The truth is we are each others competition. The greater truth is that there isn't now and wouldn't be in the future a great deal of difference between a "good chiro" and a "good PT" in terms of how they practice. Therefore working together on a patient would be redundant and unnecessary, particularly as it pertains to payment of services. I quite like the idea of a colleageal relationship with them in terms of sharing information not sharing patients. My personal experience is that patients come from chiropractors with a dialogue and mind set that is difficult to overcome for advancing the notion of patient responsibility and independence. Fortunately, or unfortunately there are and probably will always be plenty of patients to go around.
Tim
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Re: PTs working for Chiros? - March 1, 2005 3:32:00 AM
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TMondale
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From: Newton-Wellelsley Hospital
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Since nobody is responding to the last post. A question for all. How many of you would treat a patient in conjunction with a chiropractor?
Tim
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Re: PTs working for Chiros? - March 1, 2005 4:12:00 AM
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VagusX
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Tim,
In a perfect world every health professional would work in harmony. Competition wouldn't exist. Of course we do not live in a perfect world and every PT has seen this mind-set that Chiros have placed upon thier patients. Many times this isn't good for a former chiro patient coming into PT clinic.
The main point that I was trying to make is that at the Army base that I worked at there was very little to no competition between professions. Soldiers would frequently get adjustments from Chiros and receive PT at the same time and I rarely heard disagreement from the PT. AS long as the patients are getting better why should there be disagreement?
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Re: PTs working for Chiros? - March 1, 2005 5:44:00 AM
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TMondale
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From: Newton-Wellelsley Hospital
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Thanks for the response. I don't have any experience with the military way ( and am admittedly envious of the way our military colleagues are allowed to operate). However what I don't understand is how does a PT know the effects of their interventions when there is somewhone else doing the same or similar? You wouldn't advocate absolving your responsibility to assess and treat the joints in any case I would guess. Everyone should be concerned with the medico-legal ramifications of such an association. The chiro does his/her thing then they come to us for exercise? That shouldn't even compute.
Tim
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