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The APTA's Vision for 2020
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The APTA's Vision for 2020 - August 31, 1999 4:51:00 PM
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Randy Moore
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Joined: July 6, 1999
From: Columbus, OH USA
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I was suprised to see the APTA's vision statement for 2020 written in this issue of Orthopaedic Physical Therapy Practice, vol.11, no. 3, 1999. Although this statement was labeled a draft, I could not believe the statement "Physical therapy is provided by doctors of physical therapy who are primary clinical care practitioners...". I guess they plan for all PTs to return to school and get a DPT. A similar plan to the ongoing attempt to make all schools master's programs by 1990, which is still heading toward that goal. I wonder how does this make other clinicians feel? What are your thoughts? If you have the issue please read this statement on page 32, and share your thoughts.
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Re: The APTA's Vision for 2020 - September 3, 1999 9:25:00 AM
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LAMCAT
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Joined: September 2, 1999
From: Florida, USA
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The future of PT,well who has their crystal ball working lol!! We need the politicians to realize the horrible effect that the Prospective Payment System(which was in the BBA of 1997) has and will continue to cause to our profession as well as OT,ST and RT.There is a internet petition that seeks to have the restrictions in the PPS repealed.The link for the petition is http://www.e-thepeople.com/petition.cfm?PETID=173393 Please read and sign and PASS it on to family,coworkers,friends etc.It is available until Oct.3,1999 and then will be forewarded to Pres.Clinton. In my humble opinion,we as a profession need to get PROACTIVE to save our profession. Thank you.
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Re: The APTA's Vision for 2020 - September 4, 1999 10:16:00 AM
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SandyPT
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Joined: May 24, 1999
From: Boston, MA
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"Physical therapy is provided by doctors of physical therapy who are primary clinical care practitioners...". An entry level doctorate is absurd. It is something to work toward if you wish become an independent practicioner but entirely unnecessary to work in an entry level position in a Hospital or Rehab facility.
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Re: The APTA's Vision for 2020 - September 5, 1999 2:16:00 PM
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kris
Posts: 130
Joined: June 26, 1999
From: Larksville, PA, USA
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Many of the articles are printed by those in academics. The significant drop in PT jobs has created a drop in students enrolling in schools. SO......this is one way to keep those interested paying those high tuition bills (and sending those who only have a bachlors or masters back to school). The questions is [IMG]http://www.rehabedge.com/forums/biggrin.gif[/IMG]oes having your doctorate really make you a better practicioner? Many would argue that experience is a much more qualified teacher. It's up to ezch individual to make the call.
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Re: The APTA's Vision for 2020 - September 5, 1999 7:52:00 PM
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Olivia Jean Box
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Joined: May 23, 1999
From: Trussville, AL USA
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I guess I'll be the "dissenting" voice on this topic. I, for one, DO believe in the Doctor of Physical Therapy as the entry level for the profession. Is that the entry level for today? Hardly. Will that be, or should that be, the entry level for 2020? a resounding YES! It only takes a cursory review of the available literature and advances in technology to realize that PTs KNOW more/NEED to know more about their patients than they have in the past. Physical Therapy is a profession that is continuing to evolve from the Reconstruction Aides of 1917 with only months long education and training to the master entry physical therapist of today/tomorrow. Quite often those in "academia" may seem to be perched in "ivory towers" that far removed from the reality of everyday practice. Please remember that many if not most academicians are clinicians as well. These dual roles with their concomintant responsibilities provides the bases for making and promoting this "Vision" of the profession. Growth is sometimes painful but necessary for survival. Physical therapists who are concerned about the doctoral degree should voice these concerns and work with APTA in reaching the "balance" that opposing forces create. That, my frends, is what physical therapy is about.
Jeannie Box
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Re: The APTA's Vision for 2020 - September 6, 1999 6:58:00 AM
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Cranial
Posts: 46
Joined: September 4, 1999
From: Plainville, CT USA
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The DPT used to be Diploma in Physiotherapy to designate those who had graduated from private or technical schools from those at university programs. In the Soviet system, to become a DPT you first went to med school and then did an 18 month specialisation in PT while your classmates may be specializing in cardiology, internal medicine, etc.
The present DPT programs are only a few science credits above above the good foreign bachelor's programs that are 4 year PT specific education programs. According to my physician friends; in the future the DPT will be remembered as a out-moded vaccination, not as a profession with a long history of distinguished service.
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Re: The APTA's Vision for 2020 - September 27, 1999 6:40:00 PM
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Ryan S. Gephart
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From: Toledo, Ohio
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I have a BSPT. Was told we did graduate level work but sorry, no MSPT. Fine...all I wanted was a degree and get my license. The masters would have been nice because I think I eventually want to get my PhD. Not 100% sure 'why' but it is a possibility in the future because, well, I like school. But...I'll go on for more education on my own accord.
Unless there are HUGE changes in how this entire system works, I don't see how the DPT can make that much difference if not be a considerible waste of time. "PT provided by primary clinical practitioners..." I already mentioned I have a bachelors degree and I already delegate alot to my support staff because of the paperwork load. I don't care what is after your name...until you have the hands on experience a PT with BS or BA is no greener than a DPT or someone with a PhD who decided to get a PT certificate. Green is Green. Unless the DPT programs have a residency in PT or something, I don't see how the initials will change all that much of what really goes on down in the trenches so to speak.
So...what will this DPT have that someone with fives years experience and their OCS or other specialization doesn't have?? If they are going to go that far we may as well drop it all together and do what is mentioned above...make PT a MD or DO specialty...I find it hard to believe that in my lifetime, we will be able to compete with MD's, DO's and DC's. Then again, stranger things have happened.
At least for now...I'm in it for the long haul as a PT since so far, "a bad day in the clinic is better than a good day most other places."(a quote from my mentor, the late Christopher P. Roberts, PT).
Ryan
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Re: The APTA's Vision for 2020 - September 28, 1999 1:17:00 AM
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Rose
Posts: 122
Joined: September 19, 1999
From: Ohio
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It is obvious that our profession is in trouble. Thousands upon thousands of therapists unemployed (without Master's Degrees), the majority of the rest of us have taken pay cuts, hour cuts, benefit cuts. The picture won't change much.... in "all my years" I have never seen the government/insurance companies take something away from the public and then give it all back. We don't need more education for our therapists-in-training we need BETTER, more intense coursework at the BAchelor's level. The cost of education is herrendous as is....and if the field of PT isn't waiting with open arms for all that want to join it then don't encourage masters level entry requirements.
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Re: The APTA's Vision for 2020 - September 28, 1999 3:47:00 AM
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Dana D
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Joined: September 18, 1999
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I agree that something has to be done... on the educational level/the board of accreditation level (CAPTE). Therapists who have been in the field for 20 years now, remember when CAPTE was saying "no more new PT programs unless they are master's programs...by the year 1990" and then, while I was in school, it was "by the year 2000" so on... Well, I graduated from a bachelor's program who just received national accreditation by CAPTE in late 1998. Bachelor's, not masters as was the grand plan of CAPTE... Like you had said Ryan, my director told us we did more intense work, similar to a masters level, (conducting year long research...) but...sorry no masters...
Don't get me wrong, I'm not complaining because I would of been in a horrible situation if we did not receive accreditation... I would not be where I am today.. But my PT program should not of accepted students without receiving accreditation in the first place... And CAPTE or the APTA need to make a serious stand, not some measely projection, limiting the development of more PT programs... Enough is enough! In NYS alone, I could of went to 10 programs (just thinking off the top of my head at 7:30am.....), 3 of them being in Buffalo! I think there is enough programs......And I noticed more and more once I graduated....which obviously has contributed to the difficulty many classmates had in finding a job and the salary we are receiving...
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Re: The APTA's Vision for 2020 - October 9, 1999 4:34:00 PM
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Andrew M. Ball, MS, PT
Posts: 500
Joined: October 8, 1999
From: Chapel Hill, NC, USA
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Here's the deal folks, a professional physical therapy degree, at any level (DipPT, BS, MS, or DPT) is no longer sufficient if you plan to retain the freedoms that we have enjoyed in the past. A professional (entry-level degree) AT ANY level, is about as useful as a BS or BA in psychology or communications. Can you get a job? Yes, but most students understand the need to continue their education with an advanced degree. Consider this . . .
Have you considered what the value to a law firm may be of a PT who took 6 months of their time to complete a paralegal certificate?
How about the value of a PT with a master's in computer science or engineering to the biotechnology firm attempting to build a low-cost prothetic limb which actually recieves implules from the central nervous system of the patient?
If pediatrics is your bag, have you considered the value of a PT with a master's in special education to the local school system?
We must also consider the prospect of non-clinical positions such as insurance claims review, or case working.
We have failed in the justification of our profession. Edgerton, Dobkins, Seif, and others have shown the marked effectiveness (70% in terms of ambulatory independence and gait velocity) of partial weight bearing over ANY other method of traditional physical therapy gait training, yet most clinicians still have no clue. The P.S. will be that this opportunity will be another one lost to rehab nurses or exercise phys.
About a year ago a study in the N Engl J of Med entitled "A comparison of physical therapy, chiropractic manipulation, and provision of an education booklet for the treatment of patients with low back pain" showed that:
FOR PATIENTS WITH LOW BACK PAIN . . . PHYSICAL THERAPY AND CHIROPRACTIC MANIPULATION HAD SIMILAR EFFECTS AND COSTS, AND PATIENTS RECEIVING THESE TREATMENTS HAD ONLY MARGINALLY BETTER OUTCOMES THAN THOSE RECEIVING THE MINIMAL INTERVENTION OF AN EDUCATIONAL BOOKLET. WHETHER THE LIMITED BENEFITS OF THESE TREATMENTS ARE WORTH THE ADDITIONAL COSTS IS OPEN TO QUESTION.
As a student of healthcare managment, I'll answer the question quickly for ya'll. NO, it does not. Based on this study, any HMO physician, whose financial incentive is to reduce referrals, will use the booklet method at about 1/4 the cost, and see near-equivocal results in his patients.
We are experts in the function of the neuromusculoskeletal system and few dispute this, but the sad truth is that such an expert is not viewed as particularly necessary by the population at large. Coupled degrees, not elevated degrees may be part of the answer.
As for those of you who ask should BS and MS trained therapists go back to school, in my opinion, the answer is a resounding YES, but only if the advanced degree will improve job prospects as described above, or improve our clinical effectiveness. I've seen more than my share of "experienced" therapists with 20 or more years of experience. Some are in fact excellent, but the vast majority have been practicing on faith, without picking up a journal, or attending a research seminar (NOT a continuing education course where anecdotal stories are presented and skills in less than proven interventions are perfected) for the WHOLE of their professional career. Do you need to go back to school? Depends, but here's a quick test . . .
Can you explain the concept of the central pattern generators to your patients?
Can a human being walk if the cortex is removed? If the entire cerebrum is removed? Why or why not?
What is the most effective intervention for gait training?
_________________________________________
The answers are
1. The central pattern generators are located in the spinal cord. The most significant neuroanatomical area for walking is the reticular formation, without which walking would not be possible. The higher brain controls higher functions only, such as velocity of gait and intended target.
2. Based upon animal studies, a human being, if rehabed correctly, should be able to walk with little error, even if the entire cortex is removed. Given this, it should be possible to rehab any client with any kind of upper motor neuron lesion. The inability to do so markes a serious flaw of our profession. Decerribrate individuals would have a bit more trouble, considering with the thalamus removed, vision would be gone. It should however be possible.
3. Partial weight bearing over a treadmill. The effects of adding facilitation techniques to this therapy are unknown, but this is where we may be able to conduct research to justify our existance! If you are still using NDT or PNF alone, you need to consider either picking up a text or going back to school. You CERTAINLY should not be taking students and re-training them to use ineffective antiquated techniques.
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Andrew M. Ball, MS, PT
MBA/PhD Candidate
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