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Re: Should PTs be called "Dr."
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Re: Should PTs be called "Dr." - January 12, 2006 3:05:00 PM
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srcase
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Drew and all,
My comment about the underlings was tongue-in-cheek. I guess my tone didn't come through in the post....go figure!
;)
Sarah
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Re: Should PTs be called "Dr." - March 13, 2006 9:14:00 AM
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Zeke W.
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The term "doctor" is slowly losing its meaning. Just around the corner we have, "The Car Doctor" and on the other corner, "The Grooming Dog Doctor". I think everyone should be called doctors because it it basically useless terminology, but it sure makes some people feel important. Yes, isn't it wonderful when the restaurant hostess yells out, "Dr Jones! your table is ready!" Everyone looks to see the proud and professional DOCTOR Jones! WOW!
Zeke
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Re: Should PTs be called "Dr." - March 13, 2006 10:41:00 AM
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james097
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I did hear that the grooming dog doctor was in some trouble with his College as he had yet to finish his dissertation, but a doctorate in the doggy business will no doubt give him the leg up he needs. I treated The Czar of Tar a few times,he did driveways, but I didn't think less of the Russian Royal family because of it.
Vanity number plates around here have catdoc, katdoc, dogdoc, footdr,eyedoc but no ptdoc as yet. The one I like best and is a urologists, it states pb4ugo.
Jim McGregor
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Re: Should PTs be called "Dr." - March 13, 2006 12:47:00 PM
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Shill
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There used to be a restaurant in LaCrosse Wisconsin called Pizza Doctors. Of course, you would just bring in your pizza, and they would prescribe some meds for it, and send you on your way.....
Im with Zeke. And by the way Zeke, your waitress probably has a Doctor of Waitressing degree, so watch it mister!
Im losing one of my greatest assets... patience. Weve got such alterred priorities that it is a jucking foke. We might get doctorates, but we still need to get an MD to scribble their name on a piece of paper so that an insurance company will pay for the walker that we determined they need. That, my friend is rucking fidiculous.
Please, no one tell me I need to see the big picture either. I see the little picture staring me in the face every single ducking fay. Its the little pictures that we piece together to form the big picture. Its a mosaic. Its not the big picture that we break apart retrospectively to fix the little picture. Alterred priorities I tell you, alterred priorities.
That felt good.
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Steve Hill PT
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Re: Should PTs be called "Dr." - March 15, 2006 8:08:00 AM
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dosrinc
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From: Bonita Springs
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Drew, let me make sure I get this right
You have a DPT, PhD and an MBA? It wasn't quite clear in your post.
Just kidding!
Rick
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Re: Should PTs be called "Dr." - March 15, 2006 10:16:00 AM
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Wisecracker
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Rick,
That was rich...well done;)
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Re: Should PTs be called "Dr." - March 15, 2006 4:57:00 PM
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Andrew M. Ball PT PhD
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Rick,
I get that you were kidding, and yes, I'm a nerd degree collector, but don't miss my point. A staff physical therapist is just a staff physical therapist --- BSPT or DPT/PhD. If it strokes the ego of a novice DPT, or even an experienced one, to be called "doctor" then go for it. Seems a little ridiculous, insensitive, and professionally stupid to demand it though --- especially considering how crazy it is likey to make referring physicians and supervisors WITHOUT the DPT.
Drew
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: Should PTs be called "Dr." - March 16, 2006 4:44:00 AM
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dosrinc
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Drew,
PT's are autonoumous professionals, I do not agree that any of us should be considered "Staff PT's" but that is a whole different discussion.
Rick
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Re: Should PTs be called "Dr." - March 16, 2006 11:56:00 AM
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nari
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Shill
Well said. The big picture functions if the little pictures are all working towards a common goal. It appears not all want that common goal because it is not clearly defined in terms of priorities.
Nari
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Re: Should PTs be called "Dr." - March 16, 2006 3:32:00 PM
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JLS_PT_OCS
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Steve's rant is understandable, but only so if you consider a doctoral degree the priority for the APTA. It isn't. It's just a means to ends we can all agree on:
1. Autonomy
2. Direct access to patients and to reimbursement from payers
3. Freedom from the restrictions other professions would place on us for their own financial benefit
Myself and others (including APTA) have been saying this same thing for some time. I wonder if people really want to understand, or just to complain. As long as people choose to focus on the "D" word and the degree, many will continue to disagree with it. Only when they focus on the ends listed above do they understand.
People, for the last time, it's a means, not an end. Get over it.
J
ps I can't believe this thread won't die...
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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: Should PTs be called "Dr." - March 17, 2006 4:18:00 AM
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chiroortho
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Hey if I was a PT I'd sure get the DPT. I'm the kind of guy that wants to achieve the highest level of certification in my field and I completely understand the rationale behind the PT profession wanting to move toward recognition as a doctor. It may not be universally accepted now, but I think the upside greatly outweighs the downside (eg because it's new, some MDs might be defensive or offended but that's to be expected).
Expanding scope is a good thing IMO. Maybe after a decade or two the DPT credential/extra training will facilitate scope expansion. Although the DPT is in its infancy, with time the concept will mature and the training will get better and better.
Look at it this way: if nothing else, how can it hurt to learn more? That's one of the reasons I spent over four years in postgrad training to become a DABCO. It doesn't expand my scope, I can't do (from a legal standpoint) one thing that a DC without the extra training couldn't do but my knowledge/training has increased exponentially. There's only so much that can be covered in the standard chiro school curriculum due to time constraints. For example, I didn't learn how to cast fractures, learn to use doppler, etc. in chiro school and in ortho training we did that and so much more. So I'm all for getting as much training as you can. I can tell you this - I enjoy a greater sense of achievement from completing the ortho program and passing the boards for that than I got from my DC degree.
Greg
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Greg Priest, DC, DABCO
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Re: Should PTs be called "Dr." - March 17, 2006 4:37:00 AM
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dosrinc
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Greg, I agree with you completely and it is only those PT's who dont have the same desire to achieve the highest level of certification in the field that will complain about the DPT, like I have said many times before, I have never met a DPT who was upset that the APTA vision 20/20 promotes the DPT as the direction the profession needs to head.
Rick
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Re: Should PTs be called "Dr." - March 17, 2006 5:46:00 AM
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JLS_PT_OCS
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Well said, as usual, Greg.
J
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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: Should PTs be called "Dr." - March 17, 2006 1:01:00 PM
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Andrew M. Ball PT PhD
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Greg,
Well said. The current frustration among DPT's, however, is that the clinical climate isn't quite there yet in most parts of the country, or in most speciality areas. There are some exceptions, but in most clinics, DPT's are overtrained for current practice. The problem is that most DPT's have 6 to 12 months of mentored clinical work under a PT. Where are those clinicians who have the clinical and philosophical understandings to mentor students in the clinic going to come from? There are many, many BSPT's and MPT's out there with TONS of advanced NMS clinical training, but not the slightest idea of how to differentiate back pain that requires referal from back pain that can be safely treated without MD involvement. How are "experienced" PT's with gaps in what the DPT of 2020 will be expected to do, train students effectively? Simply put, they can't. At least not fully and completely.
Today's DPT IS NOT the DPT of the 2020 vision, but they (we) are the trainers and educators of today's students that will be the 2020 vision. The frustration among most of us, however, is that isn't what was (or is) being sold in these programs. It's not what we signed up for, but it is what the profession needs of us.
Personally, I fully understood this before starting my DPT and accepted it as a responsibility I had to the profession that I love. I never expected a life-change, but as I speak with many former post-professional DPT classmates who thought that their lives would greatly change upon transitioning from BSPT or MPT to DPT --- other than what is generally felt to be deeper and more comprehensive care of the patient --- not much has changed for them, and their colleagues certainly don't support their DPT. Most are threatened by it.
As a result, many DPT's (myself and my wife among them), choose where and when we present ourselves as "doctors." I understand the peril of this completely --- if all DPT's play down their degree, the intended vision of the DPT will never be fully realized, and that will be a shame. My guess is that many PT's work with, or know DPT's who conceal, or at least refrain from talking about, the fact that they've earned one.
Drew
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: Should PTs be called "Dr." - March 17, 2006 1:24:00 PM
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SJBird55
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DPTs are overtrained???? what???? Come on... what the heck? Drew, you read on PTManager. What do managers say? Sure, there are some good recent DPT grads, but overall, a manager will hire a PT with experience before a recent DPT graduate.
If a PT wants to get a DPT for the feel good reason of achieving a higher level, fine by me. But... no, nothing changes. That's the whole rationale for not getting the DPT. NOTHING changes. LOL If someone needs structure to learn and needs that little piece of paper or that title to prove to themselves what they have achieved, then great. There are lots of tother options out there for PTs to be headed in the 2020 vision, that tecnically, the DPT is just one option. We definitely can be responsible and resourceful and have the clinical knowledge of a person with a DPT without going through some big formal process.
I know my referrals from physicians are always "evaluate and treat." Other than the step of me always needing to get a physician signature, I'd say that I have been practicing pretty autonomously in the sense that yeah, I can pretty much write up whatever plan I want and the physician signs it. Good to go. The utopia world would be to either have or not have a referral, see the patient and send a "consultation note" to the primary care provider or surgeon AND get paid for it.
The thing that makes me laugh is that #1 there is nothing supporting improved quality of care by a DPT #2 there are no actual competencies that really assess anything we do #3 there is very little occuring in measuring outcomes #4 a license is a license (there is no difference in the process). The DPT is just a band-aid for addressing what we really want professionally. If we really wanted quality and competency and wanted every PT to stay current with the ever changing technology and evidence, then by golly, our association would be tracking our continuing education and would be involved in ensuring competency AND to push it even further, those types of agendas WOULD be included in every state practice act.
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Re: Should PTs be called "Dr." - March 17, 2006 3:23:00 PM
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nari
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SJ
Sounds like you have trained your local doctors well..and that is important. Good achievement!
Generally:
I have to agree on one point in this thread, (made by SJ) is the #1 in her last paragraph above. Having a higher degree does NOT guarantee improved quality of care.
I have seen PHDs treat with very little if any EXTRA expertise in clinical reasoning/application than an average experienced PT with a degree (which they all have in Oz). Sure, they may deliver a complex and integrated process of thought...doesn't mean the patient will do any better.
Amen.
Nari
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Re: Should PTs be called "Dr." - March 17, 2006 7:44:00 PM
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Andrew M. Ball PT PhD
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Although I agree with your point that the profession has dropped the ball with respect to expecting a minimum of specific competencies among rank-and-file clinicians, I'm so sick and tired of people who don't know what a DPT entails trying to tell me what it does, and does not provide! Experience, in itself, counts for NOTHING. Usually it's the same year over and over again. It's the type of experiences that MAY count. Study after study shows that experience counts for ALMOST NOTHING. Heck, your pals Drs. Whitman, Fritz, and Childs recently published a study with that conclusion.
I'm not just saying that DPT's are overtrained, but the handful of PT's who have taken primary-care-CEU or inservice coursework from people like DuVall, Boissinault, or even (to a much less and less presigious level) me, are overtrained for current practice too --- DPT or not.
For the sake of discussion, however, I’m willing to test that theory, however. Let's see what YOUR experiences have trained you. Do you REALLY think that you're just as capable as a well-trained DPT to tease out these issues, or do you think that you're just lucky to have never been sued for the AAA, ruptured appendix, pulmonary embolism, gall bladder problem, perforated colon, etc., etc. that existed, but you missed and never knew about . . . issues that the well trained DPT would have screened for and appropriately referred?
Okay then SJ, put up or shut up. Wow us. What questions would you ask a patient with left shoulder pain radiating to the right shoulder? Are you sure that the pain is NMS? What else could it be? What it is LIKELY to be if not NMS? If not NMS, would this be an emergent situation to refer to an MD? If after hours, would you send the patient to the ED? Let's suppose it's simply back pain --- what other organ systems MUST you screen, and how do you go about asking the right questions BEFORE even touching the patient? Again, If after hours, would you send the patient to the ED? Do you take responsiblity if you miss something serious?
A PT who can't quickly answer the above questions, in my opinion, has NO BUSINESS seeing patients portal-of-entry. While you may be able to treat safely most of what comes through the door without MD involement --- some patients will require referal --- and they should expect that the PT will be skilled enought to decide what can be treated safely and what cannot. In general, in my experience, DPT's, even novice DPT's, are more likely than their BSPT or MPT counterparts to be able to answer most of the above questions --- regardless of BSPT or MPT years of experience.
Don't think it's important to know the difference between what's medical pain that may be DANGEROUS for you to treat versus NMS pain? Okay, I'd disagree, but okay . . .
How about this . . . what's the most sensitive and most specific clinical test for a SLAP lesion? Isn't it important to know this so as to refer appropriately without "crying wolf?" How about what 3 clinical tests combine to elevate specificity for supraspinatus impingement diagnosis to over 97%?
Knees your thing? Okay, besides the subjective history, what's the most specific clinical test for diagnosis of an ACL injury? How specific is it? How sensitive is it?
An autonomous physical therapy professional working in outpatient should have the answers to ALL of these questions at their fingertips. Sadly, most PT's don't (and I'd suspect, no offense to you, that you don't) . . . but most DPT's do. I'd argue that the ability to diagnose at this level, to AT LEAST be able to define what is a NMS problem that can be treated without MD referral and what is not, is a MINIMUM requirement for safe and autonomous practice. I don’t find your resistance to the DPT, nor your likely dismissal of the importance of this kind of information surprising, however. It’s very easy to cast aside as unimportant that which you don’t possess, understand, or support. In that regard, DPT’s are over trained for the positions and roles that the elders in this profession allow for them to play. Your last post, like it or not, is an example that proves my point.
I eagerly await your responses.
Drew
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: Should PTs be called "Dr." - March 18, 2006 5:14:00 AM
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SJBird55
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Drew, knock off personalizing the argument to me. I would think that with all the education that you have that you could debate in a more objective manner. So, let's keep it objective and not personal. My arguments are not aimed toward any person, but specifically toward the faults of the whole logic of a DPT.
I KNOW experience counts for nothing. I've read the same stuff. But, I still hold fast to what I said - most managers/supervisors/directors WILL hire someone with experience instead of someone with a recent DPT if the option presented itself. THAT is reality. THAT is the reality of what happens when decisions are not based on evidence. That is what happens when decisions are based on assumptions. And that is what happens when decisions are made without any actual data on performance. And actually, the poor directors/managers/supervisors really don't have much "evidence" in choosing quality PT's... so, one might as well flip a coin. From Resnik's qualitative study, the types of questions asked during the interview process would be different than what may actually occur. That is the only literature that I have seen that assists in learning what an "expert" therapist looks like.
I beg to differ. We are NOT overtrained if we have taken courses on primary care. Seeing that I am my own boss now, I use that stuff that I learned 4 years ago ALL the time. At the hospital setting where I WAS employed, it was considered a non-conformity to use any forms that were not authorized by management. Also, believe it or not, management did NOT believe that it was appropriate to put on a thinking cap and make sure that a patient shouldn't be referred on (because, the patient saw a physician and the physician provided a diagnosis). IF what I experienced IS common throughout our profession, we have a whole lot of therapists working in systems providing inadequate care because of the assumption that the physician ruled out everything so PT is appropriate. Every single one of us SHOULD be doing what the primary care instructors term differential diagnosis. Besides, literature indicates that WE (especially those with specialty certification) are much better at neuromusculoskeletal screening/training than a family care physician. We should use that evidence and definitely have primary care continuing education, direct access or not.
You want to personalize it... I'm not going to go into detail... but I have time and time again stood up and not treated a patient (against a physician's wishes), provided my rationale and referred the patient back to the physician. Of course memory is never a good thing to fall back on, but I do know in one case that the primary care physician called me back about 8 weeks later and told me that I was perfectly correct. That particular patient got sent to MSU to the DO's there for manipulation and treatment because I refused to treat the guy. Hmmm, they treated him for a good 6 weeks with inconsistent results - where did the patient end up finally? - in the hospital. He had an infection of the spine - can't remember what, but I do know that the primary care physician called me up and apologized that he should have listened to me and that the patient had an infection which was quite rare. (At the time the patient saw me, he had no red flags or anything. It was just that after a week of PT, he wasn't responding appropriately or as I had expected and my gut told me something wasn't right. And I felt badly that I couldn't be any more specific in my rationale that he just wasn't responding appropriately. At the same time, I don't feel too bad because the DO's that treated him for 6 weeks didn't think there was anything substantial going on.) No, I've never been sued and I disagree that because I don't have a DPT that I'm "lucky" to have not been sued. It doesn't take a DPT for me to know that differential diagnostic crap and to know when something isn't right. I would know if I screwed up in screening a patient - I live in a quite small community. Word ALWAYS gets around. I do not have a reputation of missing anything yet... in fact, my reputation is quite the opposite. The nurse practitioner in one local family care office chose to come to me (versus the hospital site right in the same building) because she knew I'd be honest in my thoughts and in my approach.
I never stated that it wasn't important to know the difference between medical pain and neuromusculoskeletal pain. I don't believe it takes a DPT to know that though. LOL
I am very, very weak in memorizing crap. I do NOT know all the specificities and the sensitivities of the special tests. Personally, I'm actually quite pissed that in grad school the orthopaedic texts and the instructors failed to mention those types of statistics to improve clinical decision-making. BUT... I DO know that I have a really good philosophy that if I don't know something, what is MORE important is to know where to FIND what I don't know. LOL I had a goal this would be the year that I'd compile a few spreadsheets to help me with that process - especially after I bought Josh Cleland's book. And then, my next step is to include specificity and sensitivity in my clinical documentation in the initial evaluation to assist in justifying my rationale and impression. When we really start making decisions using evidence, it is a difficult process - old ways may need to be changed and change does take time and doesn't happen over night... and when one goes through the change process, our quickness declines a bit and we spend a bit more cognitive time in our processes. So, the mindset is one of "don't get comfortable, because new evidence could become apparent in 1, 2, 3 or 6 months or 1 year or whatever, but change WILL happen again." Since it is kind of an ever changing deal, it probably isn't a good idea to have everything memorized because chances are something WILL change. What has great sensitivity and specificity now, may change to where there are more relevant patterns/tests/findings that improve the decision-making process even moreso than what is known at this point in time. So, in my defense... I'm choosing to know where to find the info and at the same time come up with a plan that works for me where I can alter what I know now to change easily for new information... and for me, that would be a spreadsheet.
Please, again, don't personalize crap to me. I have crap at my fingertips. Not always perfectly in my head (which is my goal)... but I can find what I want in a heartbeat - right there in front of a patient too. There is no shame in not knowing something without some help, nor admitting not knowing something...
Head on over to medical complexity... don't use me as some proving point that we all need a DPT. I do my job quite well (I hate it when you try to put me in the defensive and this time I'm going to bite)... in fact, for some reason, the physicians in one family practice actually put their foot down and highly, highly suggest that certain patients come to me for treatment (versus the hospital site within their same building). I'm beginning to see a pattern in their referrals - they are the patients that need someone with a thinking cap. What "seems" as a simple diagnosis isn't as simple and they all have had multpile co-morbidities. In the last 4 months in particular, I have been amazed at all sorts of co-morbidities that I've never heard of or have never seen. It cracks me up because even from a half mile away, those physicians are still teaching me. LOL I have had more positive feedback in the last 7 months compared to my whole career. I have received one letter from an ortho surgeon that I think I should frame (he's a tough guy with high expectations)... another ortho an hour away wants info on me because he was impressed with my results... I've had patients that I find out have checked up on my through the community (and I've learned I come highly recommended). LOL You're picking the wrong bird to tango with and even suggest that I have a substantial amount of inadequacies because I don't have a DPT. Let's not go down that path.
I have never dismissed the importance of what a DPT learns... I'm right on top of it too (least of all in radiographs, but I don't order them nor read them nor see them). I just don't believe that the DPT is the answer. It doesn't take a DPT to know any of the stuff you presented above. All the DPT is is proof that the PT SHOULD know it, but doesn't guarantee that the PT DOES know it. If you want to use "overtrained," I guess that's okay... but a DPT is trained at entry level. Entry level is entry level. The elders in this profession are NOT the ones allowing the DPT not to play, but instead it is rules, regulations and laws. State practice acts are probably the biggest limitation and then after that would be third party payers. It's all about politics and it all comes down to money. LOL
I'm surprised that you didn't even want to discuss the more important issues regarding competency, quality and current practice patterns based on evidence. In my mind THAT is way more important than any DPT and setting standards would definitely improve our profession. A DPT is a band-aid that only addresses the issue for the time frame of the recent graduate... there is still no standard in place for 5, 10, 15, 20 years down the road.
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Re: Should PTs be called "Dr." - March 18, 2006 6:40:00 AM
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Andrew M. Ball PT PhD
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Fasten your seatbelts. Old Drew with a soapbox point thinking he’s writing an editorial for PTAdvance or the Journal . . .
First of all, good discussion SJ, don't get upset. This is a GREAT discussion and it is not my intent to get personal, but you have made yourself available to make a few points with respect to this profession. I'm asking you to go with me on this for a few posts, as I think it's bringing lots of lurkers to a new awareness regarding this issue.
You're arguing some different points, most of which I agree with, but on my main point, I'm not going to back down.
As you have made yourself available, I am using you as an example of a non-DPT who doesn't fully respect (although you may respect more than most) all that the DPT provides the clinician, and how underutilized many of those skills are because of concerns of the profession's elders regarding how it may impact physician referrals --- or make the supervising non-DPT who doesn't have all of that information in their head look to referring physicians. My point is that because experienced clinicians want to be respected by MD's above that of the novice PT, supervisors are too often actually working to stifle the skills of the DPT, and the development of the profession. It's an issue of fear, and it takes a VERY comfortable non-DPT/portal-of-entry-untrained supervisor to allow staff to use skills that he or she doesn't have, and as such can't manage or mentor.
I fully understand that non-DPT's CAN be portal-of-entry prepared, have evidence-based clinical decision making data at their fingertips, etc. --- but the fact is that most do not. That's okay, and I don't fault you, or any other non-DPT for that fear is a VERY powerful factor in decision making --- but I do object to the dismissive attitude regarding the DPT regarding these issues, especially given the usual response among non-DPT's when differential diagnostic or clinical decision making questions are asked, while at the same time yielding individual respect to the bounty of knowledge that the DPT brings. DPT's generally HAVE been trained in this regard, are NOT respected for it among supervisors for it (you're right, they DON'T care, and THAT is the problem!), or worse yet, are suppressed from using it due to the fears and ego protection of the non-DPT, non-portal-of-entry trained supervisors. Interestingly, these are generally the same supervisors that want to demand respect from their staff on the sole basis of their years of "experience."
Sure experience counts, but it's not the ONLY, nor the most weighted factor, in the equasion. Many "experienced" clinicians have blinders on in that respect, due to fear and protection of professional ego regarding what it means to mentor clinicians with skills that the supervisor him or herself has not yet earned. I get it, I just think it sucks, and it is specifically what I mean by the skills of the DPT or portal-of-entry DPT being UNDERUTILIZED.
I agree that competency, quality and current practice patterns based on evidence are important, but in my mind, that goes back in no small part to portal-of-entry skills and the ability to rattle off specificity and sensitivity information so as to be able use the best evidence to make the best clinical diagnostic and treatment decisions. The "Red Manual" of the 1980's was an initial attempt to do this very much in the way you describe (so you're not alone in thinking it was a good idea), but it was an attempt that failed for a wide range of reasons that we can go into in another thread if you'd like --- suffice to say that, by your own admissions, you'd (and most non-DPT, non-portal-of-entry trained PT's --- despite years of experience, certifications, and advanced skills) fail many criteria by which I'd measure competence, quality, and current practice. By your own admission, you couldn't answer the questions I posed. Don't get defensive about that, I didn't expect that you could, and maybe it wasn't fair of me to stack the deck like that, but I did so to make the following point:
It's human nature to want the professional standard to meet one's own abilities, no higher, and no lower. Using myself as an example, I'm sure that my supervisor, with years more experience than I in outpatient, thinks that he's got specific criteria by which he defines himself as a "better" therapist than I (mostly related to orthopedic protocols, execution of clinical test, and specific advanced treatment tricks/clinical pearls) --- but by the same token, I have several criteria by which I'd define myself as a "better" therapist with respect to differential diagnostics, evidence-based decision making based upon the sensitivity and specificity of clinical tests, etc. Who's right? We're both mature enough to realize that we both are, and patient's shouldn't have to choose. What we may disagree on is what's more important. My goal is to become an advanced clinician with a DPT, so that I personally embody ALL of the “gold standard” criteria by which we’d ALL agree is important for a portal-of-entry DPT of vision 2020.
I'm going to go out on a limb here though, and suggest that my supervisor, a HIGHLY skilled orthopedic PT without DPT, and without portal-of-entry-training is a little more open than most to discuss these issues, and that although guarded, there IS respect for my DPT and what it could bring the clinic if fully unleashed. I'm going to say that I value his experiences about as much as he values my DPT, PhD, or MBA --- but I don't think that's the norm. In general, I think there is a lot more humility and respect afforded by DPT's to advanced clinicians and those competencies than do advanced clinicians afford the skills and competencies earned by DPT's. I just think that's wrong, unprofessional of us as a profession, and thwarts realization of vision 2020. Your comments, and the reality with respect to managerial hiring patterns, is proof of that. It IS reality, but that doesn't make it right.
Furthermore, a longer period of study to become a DPT has tended to produce a more passionate professional. New graduates of this decade are FAR more likely to seek post-graduate clinical fellowship, advanced research doctorates, stay in the profession for an average of 10-15 years (up from only 5 years 10 years ago), seek clinical specialization, etc. The effects of which will not be realized for several years --- but I trust that ALL of us would agree it to be a positive shift!
The DPT, as I've outlined above, is MUCH MORE than a band-aid, as I've described above, and your (and other non-DPT's) characterization of it as such, is both ignorant and offensive. No t-DPT gets a DPT thinking what it will do for himself or herself as an individual, we do it because we believe in the professional development shift that it represents., What I don't understand, SJ, is how you can AGREE with all of these professional shifts, yet be so dismissive of the DPT as an effective and efficient means to get the profession to that place.
Drew
_____________________________
Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: Should PTs be called "Dr." - March 18, 2006 8:23:00 AM
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SJBird55
Posts: 2357
Joined: May 10, 2004
From: Michigan
Status: offline
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Drew... whether in written form or orally, when someone asks of you not to personalize your thoughts to him or herself (in this case), I would think that it would be common courtesy to respect that wish. I did NOT make myself available to you to attempt to get an emotional response out of me OR to attempt to degrade me OR attempt to generalize your conclusions toward those with a non-DPT toward me. Of course I'm upset... read what your initially wrote and the path in which you want to go down. I do not have to prove my competency to you. Logically, assess what you did - if I responded to all your frickin questions in regard to specificity, sensitivity and differential diagnosis, I lose either way. 1) I'd either NOT answer them to your standards or 2) I'd be criticized for utilizing resources. I can't win in that kind of questioning or debate. It is unreasonable and ridiculous to go into a discussion in that manner. I'm not stupid and I'm not going to put myself into a predicament where either way I come out as a loser. You should know that this bird is smarter than that. In any part of your above response that you decided to say "you" or lump me in with all non-DPT's, I am going to purposefully ignore the comment. I'll continue the discussion, but I DO expect you to follow some common courtesy/respect rules. You want your "teaching" and "editorial" moment, and that's fine, but don't go attempting to point any finger at me. You don't know me; you don't know how I practice; and you can't judge anything about me (DPT or no DPT). So, I'd appreciate no generalizations toward me. Thanks..
Supervisors will stifle the skills of a DPT mainly because most of those with a DPT, IF they are just starting out professionally are recent grads. Supervisors would generally prefer someone with experience versus a recent grad (no matter what the degree). The "experience" a seasoned PT has isn't just clinical in nature, but also in terms of coding and those kinds of issues. Our profession is currently in a PT shortage, so yeah, a supervisor would probably hire most any warm body, but given the choice of any recent grad or an experienced PT, the supervisor would take the experienced PT - mainly not because of outcomes, but because business is probably busy and there isn't any adequate time for mentoring. I don't believe it is an issue of fear, but an issue of time, patience and productivity.
I again beg to differ that fear is not the main issue with portal of entry issues of non-DPT versus DPT. I believe it is more of an issue of time, commitment and accountability. And, maybe even toss in the experience I had with my supervisors and their attitudes... it might even subtly be related to money. IF therapists do a great job at referring on or determining inappropriate referrals quite quickly after evaluating a patient, that is money lost in a department. (In my opinion, it is only short-term financial loss.) From a business/management perspective, it is financially better to always treat for at least 4 weeks and then make a decision. The two years worth of data that I analyzed indicates that I had 18% of my discharges discharged because I referred back to the physician or recommended a consultation by a specialist. I also had 4% of patients that were discharged secondary to not being appropriate candidates for PT. Those kinds of numbers represent clinical decision making skills, BUT from a business perspective also represent lost revenue because I didn't keep on treating and treating. Obviously, I do not have a dismissive attitude when it comes to determining when to treat and when to refer. Since there hasn't been any literature published that looks specifically at the discharge decision-making process of physical therapists, all I know are my numbers - beats me what occurs elsewhere. I'm not quite understanding that paragraph that deals with DPT's having to suppress some of their clinical decision-making knowledge. I don't really know of any supervisors that take the complete time to even discuss any specific patient issue with a PT... never happened with me in my 6 years at a hospital site (no time and no one really cared). Now, when I first graduated, I worked with a great PT who did mentor me and did challenge me and did support my decision-making process and did encourage me to think and never be afraid of my decisions.
What skills of a DPT are being underutilized? I don't understand any of that argument. I'm also not sure what you mean by experienced supervisors that are non-DPT having blinders on? Entry level is entry level and I personally wouldn't have a problem mentoring or supervising any new grad, no matter what the level. So, specifically where is the issue?
You can't determine whether I fail your standards of competency or not. You and no one has evaluated my performance in that manner and obviously a discussion board is probably not a valid or reliable tool in which to determine competency. I'm not going to go into any detail on my rationale for not responding to your questions, I answered that above... and you are absolutely correct - you wanted to bait me so you did "stack the deck." Quit stacking the deck... focus your energy on the issues.
I have always been open to discuss my thoughts, both rationally and objectively.
I will fully, and wholeheartedly, disagree that the longer period of study to become a DPT produces a more passionate professional. If that were the case, why is it that literature indicates that the poorest quality of care in the medical system seems to be provided by the physicians with the most experience? We should learn from that... we DO need to have something in place in our profession for 5, 10, 15, 20 years after graduation so that we don't follow the same pattern of physicians. Even though the literature is dealing with physicians, I think we all would agree that physicians have a longer period of study than we do, which means that they should definitely be passionate professionals... so if I extrapolate a bit, well, the longer the period of study does NOT equate to a more passionate professional providing effective care.
Now, what I DO think will add to change in our profession to potentiall assist with provision of effective care is the fact that CMS is highly suggesting that outcome measures be utilized... pay for performance is being discussed and there may be something put in place in our profession. So sad to say, but I believe it'll be the third party payers that thwart our profession into being efficient and effective and not the DPT. And, my opinion on that is that it is way too bad that we aren't spearheading it outselves and active in the implementation of the process. AND it's way too bad that we don't have data to assist in the process... that's just my opinion though.
I do not believe that I am ignorant nor am I being offensive. I am candidly pointing out the lack of logic that has been applied to the whole rationalization of the DPT. I believe I am being thoughtful and respectful in my views. I also don't believe I'm baiting you or playing any emotional cards to rile you up. The shift can occur without a DPT, in my opinion. Sure, I CAN and do agree with the professional shifts, I just really, really disagree with the DPT. It IS a band-aid. And, when I say band-aid, I mean a short-term solution. And even with that, it isn't even a true solution... it doesn't guarantee payment for services.
On a side note, I do like how the APTA and board of directors ARE going to focus on full payment for services... and the push for data collection. I saw some good changes in last week's bulletin. Changes that I believe are better than the DPT.
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