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Re: Should PTs be called "Dr."
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Re: Should PTs be called "Dr." - March 18, 2006 1:47:00 PM
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Andrew M. Ball PT PhD
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Now wait just a **** minute! I'm not the one who entered this conversation making broad, sweeping, and biased statements about the value of "experience" relative to the knowlege gained via a DPT program. I'm not the one who entered the conversation completely dismissive of the education gained through the DPT.
That was you.
It was only AFTER you decided to make the conversation personal, in that regard, that I called the value of your "experience" into question.
If you can't handle the balanced counterargument, I suggest that you don't start conversations in the offensive manner that you did.
Drew
_____________________________
Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: Should PTs be called "Dr." - March 18, 2006 2:24:00 PM
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SJBird55
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Excuse me? Read my first post... I wasn't personal and I wasn't dismissive of the education gained through a DPT. Re-read my March 17th post. There was absolutely nothing offensive in it.
You haven't offered any balanced counter argument to my original post.
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Re: Should PTs be called "Dr." - March 19, 2006 6:40:00 AM
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JLS_PT_OCS
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This is really funny, in the context of the SJ-Barrett wars...
Regardless of whether we "support" DPT or not...it's here. We can disagree all we want, but it is reality.
We should get on board with our profession, and support both the ends (autonomy, reimbursement, highest quality care) and the means (DPT, EBP).
J
_____________________________
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 19, 2006 9:07:00 AM
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FLAOrthoPT
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I honestly only skimmed most of this, I am nursing a Key West weekend. But..not in anyone's defense, because I cannot tell what SJ is exactly trying to say, but the DPT may not be producing any more qualified entry level clinicians at this exact moment. But the person with the DPT in 5 years will be better than the person 5 years out without a DPT, this of course is a genealization and you can find someone out there who defies this. I have a clinically advanced degree, an OCS, and if I felt like coughing up the money have enough course work to sit for the COMT or the CFMT. I am almost done with my t-DPT.
Going into the t-DPT program I did not feel it would help at all, but it is the subtle intangible differences of becoming a leader in the profession that is worth it. Sure I may know more than the instructor teaching the Orthopedic section, but I also may have a lot to learn about reading labs, blood gasses, radiographs. I may have a lot to learn about what is considered safe angina, and unsafe angina. Sure, I knew, for the most part, to refer on if I was not seeing objective reproduction of pain during an eval, but did I know what was an emergency referral back to the PCP and what really warrantefd a quick phone call to the ED or direct to the PCP immediately?
SJ I think you are a very passionate person, very passionate about our profession, and probably well liked by your patients,and probably deliver care that is on par with the 90-100th percentile of quality of care. The DPT may do nothing to change this for you, but you may be surprised. It is tough to be so fervent about a position in which you do not have direct experience with one side. Drew has been a PT and has a DPT, he has been through both streams, as have myself, to make this post judgment.
I am not lumping you into generalizations of research done about PTs having FEAR of DPT, etc, or thinking that their knowledge is not up to par. But to think that you know everything, or know even "enough" is just ignorance. I thought I was fully capable of any orthopedic treatment 3 years out with my OCS and manual skills, I still laugh at things I had thought during those years, and constantly challenge myself to question and to learn..
The DPT is VERY valuable, and it should be obtained for the mere fact of what Dr.Priest said: it says a lot to you peers, referral sources, and clients when you obtain every level of degree you can in your clinical setting. I think that there are some non OCS and non DPT practitioners who must be amazing, but I can pretty much guaruntee you that the DPT with an OCS is highly qualified and skilled and had shown the committment to learning that our profession demands.
If you look back some time I was a DPT "nay sayor" yet after some deep internal reflection, but the bullet and only have 2 more months to go. Am I totally a different practitioner? No, but are there measurable differences and do I feel that the extra coursework is necessary if we are trying to gain inter- and public professional respect to be able to be entry-way providers? ABSOLUTELY!!
Try to listen with an open ear, we all get defensive when core values are challenged, but to not challenge our own beliefs once in a while allows us to be stagnant to beneficial change. It is tough to even imagine that you may be a better practitioner than you already are with your advanced knowledge and years of practice, but believe it or not, you too could be an even better practitioner for your patients with a post professional DPT and perhaps an APTA accreddited specialty certification.
Please do not jump all over this, because I too was in your shoes and got defensive when I said the DPT was worthless. But once I had gone head first into the program I can see the benefits and have no doubt that our profession has been uplifted to a higher possible plateau with this new level of education.
Amen brother to jason, and drew I am on your side on this one (i think...cause I have not really read all of your twos posts) but honestly no sides are needed. This is just a prime example of the typical discourse between a very passionate and self confident PT and a person who has seen the other side.
No one is wrong or right, just two sides that are presented and we all should make up our own minds of where we want to be when our profession catches up to the mission statement it has set forth.
Ben Galin, MPT, OCS, CSCS,(DPT to be in 6/06 ;) )
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Re: Should PTs be called "Dr." - March 19, 2006 9:32:00 AM
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SJBird55
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LOL, seems to, Jas. When one can't debate rationally it always turns into a "personal" deal. Well, I purposefully attempted to keep my comments not aimed at Drew, as a person, but instead at issues.
It may be here, but I don't have to agree with it. In my opinion, it isn't the answer. I believe that complacency will STILL be an issue 10 years from now, even after there are a whole lot of DPTs.
Look at our history here in the States... we went from BS to MS. The MS and the higher education was supposed to create a higher caliber of a professional. (Think about it, when did the MS become the educational drive? I'm just going to guess 12-15 years ago?) Did the MS meet the objectives? Have any data been collected to objectively measure the impact the MS had in our profession? Has anyone taken a look at our current structure and the current provison of care that deems our services are inadequate? If there are inadequacies, are the inadequacies due to the educational level or due to some other variable?
Then, the reality that entry level is entry level... that's just plain confusing to me too. Technically, the educational level doesn't really matter - just graduating from some accredited PT program and passing the licensure exam is what technically matters.
We already know a DPT doesn't guarantee that quality improves. Besides that, we don't even have a definition of quality, how to measure quality, or what is in an acceptable range of quality.
Now, we're moving into the realm of a DPT. We have nothing in place for 5, 10, 15, 20 years down the road. (This is where we are currently at in regard to about when the MS became THE educational degree.) The issues really aren't resolved with the DPT educational degree. The DPT isn't the means, just as the MS wasn't the means. In my opinion, it's going to take a lot more work, a lot more effort and some financial burden than a higher and higher educational requirement to ensure the highest quality of care. It all sounds good, but it's just smoke and mirrors to me. In my opinion we haven't learned from our past, nor are we fully using evidence to guide our profession. If physicians with the most experience tend to be the ones that provide the least adequate care, what does that tell us?
The way to really address the issue of quality IF quality is the main rationale...
1) changes in state practice acts that incorporate an annual continuing education requirement with the APTA responsible for categorizing levels of continuing education and granting credits for acceptable courses
2) a system in place for competency targeted in the area a physical therapist tends to practice, probably again at the state level with the APTA overseeing what the target knowledge should be as minimal requirement for X amount of years(meaning, it won't be like the "competency" crap in hospitals related to JHACO - for example the age-related competency crap that is the same test year after year)
3) employers who track and measure performances based on outcomes that include some objective form of change in function or change in presentation AND share that information with individual clinicians
I believe if we just nod our heads and all agree that the DPT is wonderful and grand without any additional thoughts or any deeper thinking, that technically 10 years from now, our profession will STILL be in the same boat it is now. If nothing changes except the majority of physical therapists having a higher educational level, well, nothing will really be changed except our title. A title is just a title... and all the issues of concern will still be in place with everyone wondering why those issues just didn't go away and become non-issues because we're "doctors."
Our posts crossed, Ben... I'm only against the DPT if the current belief is that the DPT is a means to the end... it really isn't.) And, sure, I'm sure I'd learn a lot and that a DPT would change me. Technically though, I don't believe it would be worth the financial investment for me personally - if I invest in something, I want a return. There just isn't enough return in my opinion. I firmly believe I can open and close my own doors without a DPT. A DPT may make some of my desires easier, but I don't know, I'm pretty persistent if I really, really want something and that quality tends to be what is what makes things happen for me.
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Re: Should PTs be called "Dr." - March 19, 2006 12:03:00 PM
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FLAOrthoPT
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I do have to say that us MS PT with 2-3 years under our belts are way better clinicians than the BS PT with 2-3 years under their belts. The amount of differential diagnosis and level of treatment techniques we go into is only something a very dedicated to learning BS PT got with many years of cont ed and experience. When I was in clinic life, I was 3 years out working alongside another MSPT,OCS 3 years out, a BS PTATC who was 15-20 years out. I would say that hands down the two of us MSPT were by far better clinicians and in a matter of one year of working there, the physicians were referring specifically to one of us rather than the BS PT. Now this is anecdotal, BUT...I staff over 300 therapists in the state of Florida. I can tell you that there is a big difference between the BS and MS PT. I have not staffed enough DPT yet to see if there is such a difference, nor are there too many who have a solid 3 years of experience.
Anecdotal at best, but in large numbers..
thanks for the good discourse everyone...I think this post can be officially locked down until we see what happens in the next 3 years when these new DPT have some actual clinic time under their belts...hope we're not going to be outdated!
Ben
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Re: Should PTs be called "Dr." - March 19, 2006 2:36:00 PM
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Randy Dixon
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That was almost like SJ-Barrett ll: This Time It's Still Personal.
I think SJ did a good job of trying to not make it personal this time though and I agree with most of her points. If the DPT is meant as a means to an end, then the emphasis should be on how to best make it meet that end, currently there doesn't seem much move to do that, it seems rather like "Make it, and they will come".
The difference in competency and knowledge seems to be more a matter of individual attitude and native intelligence than one of degree attained. Drew seems to believe that the actions of non-DPT's are all motivated out of fear and jealousy, not the fact that DPT's haven't proven themselves and in many cases where they have been tested clinically, don't perform as well as promised. I don't know if anyone else has noticed this, but there is a difference in expectation and, for want of a better expression, degree of arrogance among many new graduates, as compared to graduates a decade ago.
I think Jason is right also, that the DPT is the way it is going to go, and it is better to all row together in the general direction you want to go than it is to all row for exactly where you want to go. More study, and changes, on how to make DPT applicable to the stated means are in order though.
The one thing that always pops up at me is this, as Drew said, what a DPT knows, or should know, is underutilized. But if this knowledge, and time, were utilized to it's full effect then this would take away time from what they are doing now. Doctors don't NOT do Physical Therapy because they don't have or can't acquire the knowledge base, they do it because of the idea of division of labor. If DPT's began utilizing their time at it's highest use, then there is going to be a gap at the other end of the spectrum.
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Re: Should PTs be called "Dr." - March 19, 2006 3:15:00 PM
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FLAOrthoPT
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we are already seeing this, how many states is it typical to see PTs doing eval and POC and PTA doing treatment? It is rampant here in south FLA. Don't know if it is a good thing or a bad thing, but it follows the trend you speak of-
Ben
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Re: Should PTs be called "Dr." - March 19, 2006 3:22:00 PM
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matotoms
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I think DPTs smell a bit funky...other than that they are great.
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Re: Should PTs be called "Dr." - March 19, 2006 3:54:00 PM
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SJBird55
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Ben, I believe that trend has more to do with a business/financial decision employers make. In the hospital system I was in, it was highly, highly encouraged to delegate every patient to a PTA... I'm a bad, bad PT to ever have on staff because I don't tend to follow those "unwritten" rules and those expectations that are only hinged on generating the greatest profits without clinically rationalizing what is best for the patient.
I don't believe that Resnik has published some of her data, but she found that better outcomes were achieved when services were provided by a PT. She didn't get into the level of education. She found that a lower level of outcomes occurred if PTAs were involved in the care in states that have state practice acts that have something or another on supervision of PTAs (or PTA licensure?). The worst outcomes occurred in states that did not have any requirements for supervising PTAs (or PTA licensure?) and when the PT delegated and had minimal further interaction in the care of the patient.
CMS may have got wind of that information - in light of their Medicare B changes... clear documentation of who provided the service with title/credentials AND the requirement that PTs are involved in one treatment session whichever comes sooner 10 visits or 30 days.
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Re: Should PTs be called "Dr." - March 19, 2006 4:25:00 PM
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Andrew M. Ball PT PhD
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Randy,
I see your point about it taking more time to function as a portal-of-entry provider, but I don't think that it takes all the time that you might think it does. I certainly don't do a full general health screening, systems review, and review of systems on all patients (yes, systems review and review of systems are different, but that's not important right now), but when I do, it usually only adds another 5 minutes or so to the eval.
I would like to see ALL PT's asking the 7 general health screening questions of all patients, if not the review of systems questions specific and appropriate for a given set of symptoms. It's really not that hard to do, doesn't take much time, and really does help to tease out NMS pain from pain that is medical (but can wait), from pain that is medical and requires immediate ED attention.
I've done some inservices and Conn Ed. in this regard, and given the importance of the information, I'd be happy to open discussion in another thread regarding a systematic process of general health screening and review of organ systems. That's right, I'd just as soon give the information away than charge for it. I agree that too often money drives these kinds of decision and professional development --- and I agree that if vision 2020 is to be realized, and the DPT vision to be fully supported, that some of these barriers must be broken. What better way to convince the skeptic masses than to provide an initial introductory sampler? If people are willing to "tune in" I'm more than willing to open a thread and lead a discussion.
Finally, I'd like to make a point about the "quality" of the DPT. It is unfortunate to see the arrogance and overconfidence of many DPT's, especially new graduates --- but they are assesing potential employers and their skills through portal-of-entry "glasses" and finding the elders substandard in that regard (and they are right! Don't argue it. Accept it). It's really not that different than experienced clinicians looking at DPT's and evaluating them on the basis of an expectation of advanced clinical practice (which they don't have. In that regard, THEIR arrogance is unfounded. Don't argue it. Accept it). My point is that they're BOTH wrong. NEITHER criteria is appropriate. The non-DPT does not have the education to assess the DPT any more than the novice DPT has the experience to assess the value (or not) of years of clinical experience. The experienced clinician should NOT be assessed on the basis of portal-of-entry or evidence-based skills that they are unlikely to have; nor should the DPT be assessed on the basis of the clinical experience or mastery of techniques that they do not yet have. There is a biased assessment going on here, but I don't see "experienced clinicians" without DPT or without portal-of-entry skills being any more balanced and objective in their assessment and respect for the novice DPT than are novice DPT's of the portal-of-entry skills of the experience clinician. There is enough ignorance and arrogance to spread around --- and it's not all comming from novice DPT's --- it's just about different things.
I'd ask, as we're having this discussion about DPT/portal-of-entry skills versus the technical expertise of the advanced/experienced clinician . . . why is it that any one of us are content to allow our patients any less than BOTH?
Drew
_____________________________
Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: Should PTs be called "Dr." - March 19, 2006 8:29:00 PM
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dosrinc
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Ben,
As someone who worked for ten years as a BSPT before going on to attain DPT and OCS, let me represent all of those Bachelor's out there who could eval and treat circles around many of the MSPT's who graduated after me and let me also be the first to come out and say it was one of these MSPT's who had been taught manual therapy in their entry level program (something that I had none of in my BSPT program) that told me , dude, get off of your ass and go learn more about what is going on out there,
SJ, I feel like you may be about where I was back then, knowing you know more and treat better than 99% of these new grads but also realizing that there may be a few who are taking adavantage of the new opportunities and raising the level of the profession overall, it is fun and rewarding to stay at the top and to quit fighting it, there is so much to gain and only money to lose, go for it, the profession needs your passion and dedication.....
and Drew will even teach you for free, he said so himself, aren't you lucky!
Rick
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Re: Should PTs be called "Dr." - March 20, 2006 1:49:00 AM
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SJBird55
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I've already had Boissonnault and DuVall...
I really don't believe that I know everything. I'm sure I have a lot to learn and I do continue to learn. I just don't choose to learn through the DPT path.
The arguments that I repeatedly hear FOR the DPT seem to be more aimed at emotions. Think about it... rewarding, be the best, support the endeavor it's here, don't want to be left behind, almost a guilt trip (APTA has this vision), maybe somewhat of a panic deal (what will one do if they don't have the DPT in 2020, you'll be left behind)... And then for those that don't agree with the DPT, the arguments are again aimed at emotions: jealousy, fear, maybe a bit of stubborness.
Ben brought up that a DPT would open up doors and lead to a greater potential of additional opportunities. That is probably true and I would agree to that.
Many of you say that it raises the bar for our profession - of course, I agree with that. It raises the bar for now.
But... we did raise the bar how many years ago to the MS.... did that work? nope... I don't believe that the issues can be solved by continually raising the educational level. Ben suggests we see how the profession is in 3 years... well, of course those DPT's will be grand... I suggest we look a bit further -look 10 years down the road. Something happens in our career at about the 7-10 year mark in my mind - see what the current DPTs are like. The individuals in our profession as a whole either get comfortable or complacent or something and no longer take the energy or the time to stay current. The way physical therapy is practiced to day should be quite different than the way it will be practiced 10 years from now. So, what do we have in place to continue to stay current so that as a whole, the majority of us move with that moving target?
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Re: Should PTs be called "Dr." - March 20, 2006 2:20:00 AM
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Sebastian Asselbergs
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I think that SJ brings very good points to the fore. I am wondering about the "education" and "quality" issue: why is it necessary to make a degree a "Masters" or a "Doctorate" to improve the level of education? Isn't education quality driven by curricular content?
I know that status is an important issue in the competition of professions, but I also believe that SJ makes a VERY valid point by saying that your APTA has not exactly shown to be working based on evidence - where is the EVIDENCE that PTs are better when a Master or even "higher"? Where is the EVIDENCE that a DPT will make for easier direct access?
From our experience here: just regular BSc PT became direct access 13 years ago. It is a POLITICAL attempt - and has nothing to do with title.
Standards of practice, national exams are measuring sticks for the level of entry for practitioners - and are under constant review. THAT is where quality of entry-PTs is ultimately measured - not by their title...
It is here tio stay, no doubt. But I also doubt that the PT profession is going to be so much better off in the next 10 years - a lot more political lobbying is needed, while at the same time, a lot more self-policing is required to weed out the awful practices.
...carefully falling off my soapbox....
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Mundi vult decipi
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Re: Should PTs be called "Dr." - March 20, 2006 7:54:00 AM
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Shill
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Jason,
'Scuse me a bit, but you said that the APTA does not have, as a priority, the doctorate degree for all PTs.
I would beg to differ my friend. The opening sentence for "Vision 2020" is this...
"By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy."
Now where would anyone get the idea that it is an APTA priority? Get over it? Realize that we can disagree with the recommendations made by a professional organization. If we all agreed, there would be far fewer posts on this website.
Y'all need to get off your high horses, and stop looking down your noses at those of us without 500 letters behind our names.
And Rick, do not assume that those who oppose or argue about the DPT and its necessity are underachievers.
Just because I/we dont have a DPT, doesnt mean I/we dont support higher education, continuing education, reflective thinking, constantly trying to improve upon one's skills and base of knowledge. It also doesnt mean we dont support our profession.
I stand firmly behind my previous rant.
Steve
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Steve Hill PT
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Re: Should PTs be called "Dr." - March 20, 2006 10:26:00 AM
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JLS_PT_OCS
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Steve-
You need to reread my post. I never said the APTA didn't have a doctoral degree as it's goal. I said that if we see the degree as an end and not a means, it of course doesn't make sense.
Of course I realize we can disagree, that's what's forums are for. I said "get over it" because no one is forcing anyone who is a fully licensed PT to get a doctoral degree. I said "get over it" because needlessly debating something that isn't going to change is, well...pointless.
We don't all have to agree, but saying the APTAs priorities are messed up because of it's push for the DPT, while conveniently forgetting or not being aware of the other issues and work they do every day, is rather one-sided. And it's unfair to the legions of people at APTA who have worked hard to chart a course and set standards for us as a profession. Even more "get over it" because the APTA's not forcing anyone to get a degree they don't want to get. So, considering all that, I'm really mystified as to what the problem is.
SJ seems to think we should be able to define "quality" (perhaps she hasn't read 'Zen and the Art of Motorcycle Maintenance' yet) and hold our practitioners accountable to specific standards and outcomes. While I don't disagree with that in theory, since no other profession has been able to do this, I'm guessing it must be a tall order. Evidently, in the US, for us to even be able to make all these changes and compete with other professions who want to own us, we need to move to the doctoral degree. I fail to see how anyone who read the transcripts from Arkansas cannot see this.
I'm not looking down my nose at anybody, I don't have a doctoral degree yet, either. I've got no high horse to look down from.
I would suggest that anyone who feels as if they are on a short horse is experiencing something that comes from within. No degree can cure that.
I guess that's my rant.
J
_____________________________
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 20, 2006 10:48:00 AM
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SJBird55
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Just because something is a tall order doesn't mean that thought shouldn't be put into it. I really believe that the inherent problems that exist really aren't due to educational levels or training. I really believe that the issues that need to be resolved do hinge around quality, defining quality, measuring quality and setting standards. If we as a profession don't begin to do this for ourselves and begin some self-policing (nice word, Bas - I couldn't think of it at the top of my head), well, someone else WILL do it for us. I don't believe the issue is resolved with the DPT and technically, I'd rather speak my mind because one never knows who reads various threads and maybe someone may agree with me and may do a bit more thinking and maybe things could change for the better in a manner that truly does look at quality and performance in a long-term time frame versus the band-aid solution.
I honestly don't believe the APTA priorities are completely messed up. I do tend to believe that maybe the current solution is the "easy" solution. To really look at the issues and really come up with a plan would definitely entail a lot more than just educational level being addressed. It has nothing to do with a tall horse or a short horse - it has more to do with reality and what happens after we graduate and the environment in which we function.
Zen and Motorcycle Maintenance? hmmmm, never read it. Do I need to?
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Re: Should PTs be called "Dr." - March 20, 2006 11:45:00 AM
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FLAOrthoPT
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I just got my EASY BUTTON from office depot, and it is working like a charm!
Ben
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Re: Should PTs be called "Dr." - March 20, 2006 12:49:00 PM
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JLS_PT_OCS
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SJ-
I agree with everything you said.
About "needing to" read it...I'm not sure. Much of the book centers on how we approach life and how to define the word "quality" - great reading and highly recommended.
But so is that "easy" button that Ben found...
:)
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 20, 2006 2:00:00 PM
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MPTSTUDENT
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Here is what I see as the problem with the entry level DPT at least. CAPTE the accreditation for PT programs has the same curriculum requirements for all PT programs regardless of the degree earned. This means that a person could recieve the exact same education in a MPT program as they would in a DPT. In fact if an MPT program wanted to go above and beyond basic curriculum requirements while a DPT program wanted to just meet the requirements the MPT would have a more comprehensive program. I am not saying that this is the case (although with one DPT student I have been on a clinical with I believe it was in their case), but with the current set up it very well could be. If they want the entry level DPT to mean something, they need to make the curriculum requirements different. I do believe that the t-DPT is more worthwhile after a person has exerpiance.
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