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Re: Should PTs be called "Dr."
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Re: Should PTs be called "Dr." - May 7, 2005 10:26:00 PM
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Randy Dixon
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I hear a lot about the DPT, my wife is getting it, but it always makes me ask a question. What is the purpose of the DPT? I think it goes back to a question which I have never really seen answered clearly,that is: What is Physical Therapy? What differentiates it from chiropractic, massage therapy, exercise therapy, DO's, Physiatrists? If it is the equivalent of an MD why not just make it Physiatry or make PT a medical specialty?
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Re: Should PTs be called "Dr." - May 8, 2005 10:35:00 AM
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Dr.Wagner
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Randy I don't think anyone has said it is the equivalent of a medical doctorate (MD or DO). PT is a rehab science, not a medical subspecialty. It is a separate field entirely (coming from someone who has been both).
It is very much an art form...likely that 2 therapists would treat the same patient very differently.
Physiatry is a specialty of medicine, a 4 year residency after medical school. Similar to PT, but dealing more with the medical management.
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Re: Should PTs be called "Dr." - May 8, 2005 12:43:00 PM
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jma
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It can't be explained any better than that
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Re: Should PTs be called "Dr." - May 8, 2005 10:28:00 PM
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Randy Dixon
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Dr. Wagner,
I understand no one, almost no one, is saying that PT is equivalent to a medical doctorate. My question is what is the purpose of a DPT? What is PT? Is your answer then PT is a rehab science that is an art form? That probably makes sense to a PT but not to anyone else. You have your doctorate but what purpose would a DPT serve you? Any?
My reason for asking is this: First, before the step of making DPT's entry-level, or even having them at all, we should know WHY we are creating the degree. To do this we need to be able to clearly define what PT is. If we define it as a group of techniques, then we shouldn't worry about DPT's we should worry about finding the LOWEST level of training necessary to perform these techniques safely and make that the entry level. If we want to add diagnosis and assessment then we need to decide at what level, If it is at the level of a doctorate then how is that different than a medical degree? If we wish to have people medically trained doing PT, why not teach Physiatrist's what they need to about.physical therapy?
Is the DPT is entirely internally created within the profession, and is not being created to fulfill a need?
So let me rephrase my question slightly:
If you had a paragraph to tell your congressman, who knows and cares nothing about PT, what PT is, why it is needed and why the DPT is important, what would you say?
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Re: Should PTs be called "Dr." - May 9, 2005 2:10:00 AM
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SJBird55
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Physiatrists do know a lot about physical therapy. I've worked closely with two in my career - one in a rehab setting and one in an outpatient setting. The physiatrist in the rehab setting could grill PT, OT, speech, nutrition, nursing... she was amazing in what she knew. The physiatrist in the outpatient setting definitely knew a large array of treatments AND was the best at communicating all sorts of comorbidities and precautions on his signed referrals. You won't see physiatrists doing physical therapy themselves because they can make a ton more money evaluating, prescribing medications, injecting and doing EMGs.
jma posted a the possibly new classification definition: http://www.rehabedge.com/cgi-bin/ultimatebb.cgi?/ubb/get_topic/f/25/t/001629.html
The DPT discussion has happened here a lot of times. My opinion is that the DPT is a way for universities to make money. I think the reason for a DPT is more political in nature than anything else. To have "doctor" in one's title tends to elevate the person in the eyes of the public. I think that the political hope is that if the majority of therapists are doctors then the supposed autonomy will more easily occur.
I know that the majority of my referrals are evaluate and treat. The "diagnosis" provided is many times very general and many times doesn't tell me much except the person has pain in a particular location. I believe I've been functioning just fine with a MS. I already have to "diagnose" and have been doing it for years without a DPT.
You wouldn't want me to be speaking to my congressman about all of those issues. LOL I can handle the first two, but that last one, it would probably be better if I kept my trap shut. I don't think that it is needed. IF our role changes where we really did have authority to order radiographs or diagnostic testing and where we really did have authority to prescribe medications then I would personally sign up somewhere and get my transitional DPT.... until that happens, there is no rationale for me to spend thousands and have no financial gain and no change in my current role. I don't believe that I need "doctor" in my title for autonomy, for more respect, for competing with other professionals, for improving the care I provide, or for direct access if that ever happens.
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Re: Should PTs be called "Dr." - May 9, 2005 6:18:00 AM
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JLS_PT_OCS
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In my opinion, the DPT (as has been said before) is a way to preserve the practice of physical therapy and to preserve the ability of the consumer to have access to quality nonsurgical musculoskeletal and rehabilitation care from a medically-trained provider.
I do think the "doctor" thing is to put us on equal footing with other professionals who have non-medical clinical doctorates (such as podiatrists, pharmacists, optometrists) and to help defend the profession from restrictions that others would place on it. Who just happen to stand to gain financially.
Unlike a chiropractor (DC) we are trained in a scientific, medical way and our scope of practice is quite wide, from pediatric developmental delay to sports rehab, to back pain, to geriatrics, to EMG/NCV testing.
Unlike a Physiatrist (MD or DO), there are a lot more of us, and we are trained more in the direct treatment and utilization of noninvasive care. Physiatrists are great, but there aren't enough of them to meet the needs of the general population, and their skills are needed for the relatively few cases that require more invasive treatment (for example, pharmacological chronic pain management, epidural steroid injections, etc). Wags gave a very good summary above of the role of the physiatrist.
Unlike an osteopath (DO) we have training in rehabilitation techniques and more in-depth rehab science. Also, since our school costs less and is shorter, our salary requirements are lower, so there can be more of us and we're cheaper to have a consult with.
Unlike an athletic trainer (ATC) we have a much more detailed and thorough medical education in rehab science and exercise therapy, qualifying us to do a bit more than tape ankles and stretch people out. On the field athletic assessment is important and trainers have their role, but their education is rather narrow.
Unlike a physician (MD) we have more and better training in evaluation and treatment of musculoskeletal problems. Also, since our school costs less and is shorter, our salary requirements are lower, so there can be more of us and we're cheaper to have a consult with.
The purpose of the DPT is to allow PTs to continue to develop the unique body of knowledge we have and continue to be able to meet the needs of consumers in a way that no one else can.
Not everyone supports the DPT concept (SJ is one) but that doesn't mean that it isn't the direction the profession is taking and will occupy in the future.
It isn't to replace any other provider, only to better serve our patients and preserve their right to quality care.
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." - May 9, 2005 6:55:00 AM
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SJBird55
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Although, if you think about it, there is no definition of "quality care" or preset standards to be met.... so, technically it's all an assumption.
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Re: Should PTs be called "Dr." - May 9, 2005 8:00:00 AM
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JLS_PT_OCS
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Yes, but an assumption with some evidence to back it up.
There is some evidence to support the concept that physicians as well as medical school graduates (meaning pre-residency) have musculoskeletal exam and diagnostic skills which are really quite poor.
There is some evidence to support the concept that PTs accuracy in diagnosing musculoskeletal problems is superior to family physicians, PAs, and NPs, and is statistically not significantly different than that of Orthopedic surgeons.
So it's not just all assumption, there is a growing body of evidence supporting the body of knowledge and skills of physical therapists and their utility in a direct access setting.
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." - May 9, 2005 8:09:00 AM
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Dr.Wagner
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I feel like I gotta go with SJ on this one...
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Re: Should PTs be called "Dr." - May 9, 2005 9:48:00 AM
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JLS_PT_OCS
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In what way?
In that "quality care" is not well-defined? I concede that.
To deliberately subordinate our profession to another with either demonstrably poor or not as accurate exam skills? That benefits from the income we generate at our expense?
That I cannot accept.
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." - May 9, 2005 10:51:00 AM
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SJBird55
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Yes, Jason, the evidence is there that physical therapists do quite well with musculoskeletal exams.... was the educational level of the physical therapist specifically singled out in these studies (meaning DPT vs MS vs BS)?
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Re: Should PTs be called "Dr." - May 9, 2005 11:36:00 PM
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Randy Dixon
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I think SJ is raising part of the questions I have about DPT. Is DPT increasing the skill level of the therapist? If it does, but requires more training and harder standards then the argument that PT is more affordable and more widely available begins to disintegrate.
If the level of training necessary to become a PT gets high enough and expensive enough then it is going to be necessary to have someone do the actual PT grunt work.
Perhaps if we compare it to nursing. There is doctorates in nursing, but if they become the entry level for RN's who will then do what RN's do now?
I think the vision that Stan Paris gives in DPT program at Univ. of St. Augustine is that PT's will be equivalent to MD's, with MD's dealing with disease and PT's with dysfunction. This is a good goal but it is also a conundrum.
I'm all for PT autonomy, I don't believe the DPT is necessary for that. I'm not against the DPT, but I think it may be something that is currently being driven by the desire of PT's for greater status and money. I'm all for that too, but what is the value to the current health system or the consumer?
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Re: Should PTs be called "Dr." - May 10, 2005 6:24:00 AM
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JLS_PT_OCS
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This is a good point, Randy. I understand your perspective.
The point of the DPT is not to elevate the standards of the profession to some heretofore unseen level.
In fact, many other providers are taking similar amounts of credits and years and/or doing similar things with their practice acts and autonomy, only those issues are made easier because of the doctoral level of education.
I think this is a uniquely american problem.
Many other professions have made this evolution (optometry and podiatry for example), and they did not change their practice patterns or availability to consumers. The change was as much to be allowed freedom in their own profession as anything else.
And that's the central issue in PT: how to get our from under the chains (some of which are self-imposed) of being subservient to other providers. The DPT is merely a means to that end.
It is not required, and in commonwealth countries, people practice quite successfully and safely with bachelor's degrees. But something about american society (or rather american legislatures) means that if you are a "Mister" or "Ms" you will never have equal footing when debating someone who is a "Dr" of whatever. Did you read the legal briefs from Arkansas?
You could tell in the tone of the questions how different they were when someone was asking a "Dr"/chiro something, and when asking a "Mr"/PT something. That sort of title holds sway with legislatures and consumers.
So it's not about becoming physiatrists, or in any way "equivalent" to physicians, it's about allowing us to practice the way the evidence shows is cheapest and most effective for patients, and how to be able to successfully remove the chains of servitude many of us currently labor under. A means to take control of our own profession.
A DPT is still "FAR" cheaper than an MD, a DO, or even a DC. In fact, it may be 1/2 as expensive as a DC.
The total curricular change is not revolutionary, from MPT to DPT.
The "grunt" work of individual care of patients (is this what you mean?) will be maintained, as always, with the (D)PT or PTA.
The degree evolution does not change that.
I think if PT's are after more money, hopefully they realize that a DPT is not the way to do that. Look at other providers. The route to better reimbursement is control of your own profession and control of your own income stream. Only in america is this DPT thing evidently required for that.
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." - May 10, 2005 6:39:00 AM
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Dr.Wagner
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Why would a DPT be "far cheaper"?
I went to a VERY expensive private school admittedly, but I made the entire debt back (plus additional) in my first year of practice.
Randy, well, I was in Mr. Paris's DPT program and it was pretty much a scam as far as I was concerned. The level of difficulty is was nil. It was the EXACT reason i went back to medical school.
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Dr. Wagner DO
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Re: Should PTs be called "Dr." - May 10, 2005 8:03:00 AM
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matotoms
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i took paris s1 course and was convinced in the first 1/2 hour he was fake phony shill.
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Re: Should PTs be called "Dr." - May 10, 2005 8:09:00 AM
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JLS_PT_OCS
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Why "would" it be cheaper or why "is" it cheaper?
I don't think anyone doubts it is less expensive.
I'm not sure the point of the question?
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." - May 10, 2005 9:59:00 AM
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vt2c1ms
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Hello everyone. This is my first post. I was accepted to an OD school and a DPT school. I chose the DPT pathway for a variety of personal reasons. I have worked in the optometric field for ten years where OD's and MD's continually battle for the "Dr" title. MD's call OD's overly paid technicians and should not bear the name of Doctor. It seems the same with the DPT degree and the designation of Doctor. The truth of the matter is that MD's control the arena of healthcare and they will not like other professions being called Dr. whether it is now or 20 years from now. I feel it is truly a disservice to the PT profession if the deserving clinicians are not called doctor. As far as patient confusion as to who their "PCP" is, that is just nonsense. I think the DPT is the only profession where the clinician doesn't call himself a doctor. Does a DPT have a right? Yes. DPT's body of knowledge represents the doctor title and the DPT should be called doctor in his/her clinic. Should a MD be called Doctor in a DPT clinic. NO. That is not their body of knowledge. Should a DPT call himself a Dr. in an MD clinic. NO. That is not their body of knowledge. See my point? I do understand that with time and more DPT's, DPT will be addressed as doctors. I do care for the PT profession and feel it's disrespectful for a DPT not to be addressed as Dr. when they are in clinician mode. It's a complete disregard for the academia.
Just thoughts from a newbie looking from the outside,
Mark
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Re: Should PTs be called "Dr." - May 10, 2005 1:53:00 PM
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Andrew M. Ball PT PhD
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Mark,
I understand your position, but you must also understand that our profession serves many masters. Although the number of PT's working in a truly direct-access manner is thankfully growing, most of our ranks work by physicians sending us patients. The thoughts of the physician, regardless of argreement with them or not, must be taken into account. As a PT with both PhD and near completion of a DPT, I generally just go by Drew in the clinic. It's the quiet cool, and most MD's look at the PhD and either call me Doctor or "the professor" anyhow --- that took about a year of simply sending reports and signing my name with all the degrees, and wearing my lab coat that has my degrees clearly listed when treating patients in the hospital --- nothing more. We gain respect by who and what we are as clinicians, the degrees we have become impressive only after the fact. It's the art of, excuse the double meaning here --- but "Tooting your horn without blowing it."
Calling myself Dr. Ball in the clinic or in the hospital would have blown that respect. It certainly wouldn't have resulted in one of our Hospitalists asking me, in front of the Chief of Neurology, and Chief or Orthopedics, why I don't go by the title "Dr." even though I've earned a PhD and nearly a DPT. It gave me the opportunity to respond, "Because I don't have a medical doctorate, and I don't want patients or nurses confusing me with a medical doctor," and with a smile I added, "no offense."
They all laughed at the "no offense" comment and, I think, appreciated the humility. Ever since, they call me Dr. Ball when they call to check on a patient, or in professional situations where there aren't patients around. That's spread to other doctors they work with. Personally, I think that's appropriate. It honors the academia, but also takes into account the realities of the clinical setting.
Finally, I'd continue to disagree with SJ that non DPT's who've not taken differential medical diagnostic coursework are safe to provide direct access care. The ablity to differentially diagnose neuromusculoskeletal conditions is not at issue --- the ability to differentiate right shoulder pain that is NMS, versus coming from the GI system, gall bladder, pulmonary, or cardiovascular system is. I've simply not seen many non-DPT's able to safely practice in this way, and I doubt (no offense) that SJ is an exception. I simply suggest that non DPT's simply don't know what they don't know.
Drew
P.S. My wife and I would disagree with your assessment of DPT cost. It's about 100K through Duke . . .
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: Should PTs be called "Dr." - May 10, 2005 2:48:00 PM
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vt2c1ms
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Dr. Ball,
In a perfect world, I would be right. I just can't grasp the concept that some higher academia like musicians, artist, and history buffs are called doctors, but a DPT can't b/c of what our colleagues think rather than what our patients think. Oh well, I didn't choose DPT b/c of the Dr, I chose it to truly help people instead of Rx eyeglasses and contact lenses. I could be called Dr all day long as an optometrist but that is way too repititive of a job. Perhaps I shall demand to be called Master instead of doctor anyway-- :)
Mark
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Re: Should PTs be called "Dr." - May 10, 2005 2:53:00 PM
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Andrew M. Ball PT PhD
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Mark,
First of all, please call me Drew. Second, again, I don't disagree. In a perfect world it wouldn't matter. That said, you may take comfort in the fact, however, that AuD's, OTD's, and JD's aren't generally called "doctor," either.
Drew
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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