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Re: Should DPT's be called "Doctor"?
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Re: Should DPT's be called "Doctor"? - May 8, 2002 5:19:00 AM
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Mark Hirsch
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Hello, I'm Dr. - insert your name here - , I am not a physician - I will be your Physical Therapist today.
I'm wondering if that would that be an ok way to handle this situation?
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Re: Should DPT's be called "Doctor"? - May 8, 2002 5:39:00 AM
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jma
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Hello OSUPT,
I do feel that specializing in a specific field is good for physical therapists. As far as screening goes, I believe that there are two places in the US where physical therapists do initial screenings in an ER before MD's do. If it is beyond their scope then they refer to the MD's on call.
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Re: Should DPT's be called "Doctor"? - May 8, 2002 6:17:00 AM
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Diane
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Hi,
Mark, to expect a (possibly) drugged, sick, scared, stressed out person to understand "I'm Dr._______, I'm not a physician, I'm your new PT"....
Seems to me that that would just be giving them way too much to decode.
How about, "Hi, I'm Diane (or whatever your first name is), I'm a physical therapist. How are you doing?"
Diane
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Re: Should DPT's be called "Doctor"? - May 8, 2002 8:43:00 AM
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Andrew M. Ball MS MBA PT
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Bobcat,
Either I've not explained myself fully, or my words are being twisted a little bit. Never, ever, did I suggest that physical therapists should practice medicine. You missed a prime word in my suggestion regarding an expanded role for rural practice, that is to say "emergency" rural health. I'm not suggesting that therapists should be trained to set-bones, deliver babies, administer life saving drugs as a primary care physician, but rather as a primary care practitioner acting under specific supervision (via video teleconf.) on a case-by-case, physician authorized basis.
By definition, that means integrated interdisciplinary practice, closely monitored by apartnering physician when no other options exist, and when the physician determines the situation to be a critical emergency. In other words, if the patient in any of these situations can't get to a physician or ambulance in time, a PT should be trained to act (within certain life-threatening and/or neuromusculoskeletal confines) as the hands of the physician until help arrives. Think of it as advanced first-responder training, to a level that should be expected of all healthcare professionals.
That very relationship implies concurrent communication (via telemedical technology), virtual direct physician supervision, and case-by-case physician authorization. As such, the point about teratomas or any other complication of the birth process is moot because those kinds of discussions would be handled by the physician . . . in such situations, the PT should NEVER be unsupervised.
NEVER, did I suggest (as some whacked out chiropractors do) that rural healthcare and the clinical title of doctor qualifies the non-medical practitioner to act dangerously independent manner in such situations. In that vein, your schedule vignette, although admittingly entertaining, isn't at all what I'm describing. The kind of PT or DC that abuses training in that manner will eventually find themselves, quite appropriately, behind bars.
Use of this training, of course, implies an evolution of the emergency healthcare system that, to be prepared to take advantage of, physical therapy education must address.
Increasing MD recruitment to rural areas is a nice idea, but hasn't panned out.Besides, insurance and other 3rd party payers have begun to realize that PCpracitioners such as PAs, NPs, etc. etc. are far less expensive to employ and/or reimburse than MD's . . . so from a health economics perspective, MD's aren't always the most desirable model for rural care.
You and I have agreed before regarding, "nagging absence of the clinical evidence base in addition to the absence of a cohesive scientific base," so I'll leave alone except to say that I find the lack of a dissertation and publication requirement distressing, as well as the lack of additional CLINICAL coursework in most DPT programs. If, for example, NDT training, for the purposes of not treatment, but evaluation of the neurologically impaired patient is deemed to critical in pediatrics, and McKenzie is viewed as important to orthopedic care . . . aren't THOSE kinds of courses more important to infuse into DPT programs than imaging, pharmacology, diff. dx. etc.?
"The DPT is not a research doctorate," I'm told, "it is a clinical doctorate, like an OD, PsyD, or DDS." Why then, are the courses added to MPT programs not courses??? An additional year of unstructured internship (at least no moreso than MPT affiliations) doesn't cut it. I agree.
Finally, and let me say very clearly that I've had more than one professional difference of opinion with Dr. Richardson, your characterization of her regarding this particular issue is unfair. Blaming her for what happened in 1998 (the BBA and the CMS cap) is kind of like blaming Ronald McDonald when you get a bad burger --- neither had ANY control over the situation. As a result, she did the only thing she could do --- react.
Say what you will about Dr. Richardson, but she is a woman of vision. True, I may not agree with it all the time, but I for one would rather have someone thinking about the future of the profession and how it can best position itself, than someone (like many of her predecessors), who were unable or unwilling to plan the future of the profession. Ironically, you (and many, many other PT's) unfairly charge her for not having been prepared when reality, she was one of the only APTA presidents who ever looked far enough into the future to possibly have been prepared. She was, to her downfall, the victim of very, very, unfortunate timing.
As for her background, not everyone could, or should be Jack Turman, PT, Ph.D. Here's a basic scientist who will very likely one day win the nobel prize, but at the same time his research has been largely ignored by the rank-and-file of physical therapy profession, and many in academics. Are you suggesting that we need more people like this in the profession? I do . . . but keep in mind that many such people (and I'm not necessarily speaking of Jack specifically) don't really continue to think of themselves as PT's and those that do have right to be awfully bitter about the way that their clinical profession treats them.
A Ph.D. ANY Ph.D. trainees the candidate in research methods relative to the field of study. So what if that's education? Are you suggesting that we don't need people in our profession examining issues of education, business administration, or public health relative to PT? All of these folks learn research methods, just not basic science research methods.
I can't argue with your assessment of Dr. Richardson teaching the imaging course. I don't know what kinds of experiences she's had, but I will say that agents of change don't often have unyielding support from optimal people. As a result, she may not have had the ability to hire a radiologist to teach the course, so (and I'm making up a story here) maybe she did some training and did the best she could with respect to her vision regarding DPTs and radiographic imaging.
Finally, I take offense to your implication that a Ph.D. whatever the focus, doesn't teach the candidate how to apply the scientific method, and application to clinical practice.
Drew
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Re: Should DPT's be called "Doctor"? - May 8, 2002 8:57:00 AM
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mcap
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What an interesting/heated debate!!! Good to see.
I would like to weigh in with a few of my own opinions.......
First, I think we need to be honest about some of the prevailing sentiment on the DPT. Groups have different issues affecting their opinions........
1. Schools/faculty may honestly beleive that the DPT is a significant step forward and they may honestly beleive that it will enhance the profession. But there is a fair amount of self interest at work here. Enrollment is down significantly at most programs. If you were keeping two classes of 30 students, then moving to the DPT and keeping 3 classes of 20 students allows for the same revenue. Also, as more programs move to the DPT, many programs feel like they have to convert to stay competitive whether they want to or not.
2. I know many experienced clinicians who are panicked about the implementation of the DPT so they have their bias. They feel that despite years of hard work and training they feel that the public is going to respond Dr. title and they will be left out. They also see many DPT programs that are three years long......the same as their master's program.
3. Students have a vested interest in believing that they are not wasting so much money. It is important for them to feel that their skills are superior to practicing clinicians......or else.....why spend six figures on an education that won't net you tons of money in return. Most DPT students I meet are honest about what they do and don't know and are not that concerned about the Dr. title. And to be fair, they are getting some EBP orientation in school and are learning more Pharm and Radiology - the programs are evloving. But some of them feel they are already more qualified than me to treat patients directly (without one day of real experience). There is also the matter the one student who sees no difference between a DPT and a PhD. This is could be a result of propaganda from their instructors.
The truth lies somewhere inbetween all of these divergent views. The focus should not be on the title of Dr. It should be about learning the skills necessary to practice in the field as we envision it in the future. The title thing should be a lesser issue. Many of your pharmacists have a clinical doctorate. You would never know. However, the PharmD has opened some doors in industry and in clinical settings.
With regards to direct access.....what is the big deal? You can see a massage therapist without an Rx. We already have it in most states. It is never about primary care MEDICAL responsibility. It's about treating patients who could benefit from physical therapy without having to have a doctors referral. That's it!!! Imaging and meds are something that is allowed in the armed forces and it works well there. Will we have that ability. Who knows?? I think this is a side issue as well.
The DPT may be a good step for the profession. We need advanced skills. We need EBP. And we need to improve our professional autonomy and scope of practice.
But we will not know how it's going to work out for a while. It's going to happen for better or worse, so we might as well try to improve the process.
To imply that the DPT it is the answer to our current professional frustrations or to imply that direct access will solve all our problems is simplistic and wrong (no matter what the educators tell us). PTs DPT or no are still facing deficiencies in earning potential, professional and public respect and in career advancement opportunities. Increasing the educational requirements won't address this directly. For many years, DPT graduates will have to content themselves with performing all of of the same tasks that are required in PT.
We must also realize that most of the faculty members responsible for educating this new crop are the same ones who were teaching before. If advanced technology and evidence based practice weren't on the agenda before then I have little confidence that things will change significantly.
But, like I said....over the long run, this could help the profession. Programs may change in meaningful ways and perhaps...the new grads of the future will actually be better prepared. IN a local program, I know that the Patho, radiology and pharm courses are all taught by MDs and from what I hear......are quite rigorous.
Just a few thoughts.....
mcap
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Re: Should DPT's be called "Doctor"? - May 8, 2002 9:23:00 AM
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Bournephysio
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A well thought out answer mcap.
Another couple of points to consider.
If they get better training in research, DPTs may help us increase the amount of PT clinical research. I don't know if this will be significant.
DPT programs may decrease the number of physiotherapists doing PhDs. It is my understanding that we have a shortage of PT PhDs. I believe that decreasing the numbers of new PT PhDs may slow the progress of our profession.
Maybe we need a DPT/PhD program as well.
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Re: Should DPT's be called "Doctor"? - May 9, 2002 10:39:00 AM
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mcap
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Thanks folks!!!
Bourneo.......an interesting thought. However, one faculty member I spoke with indicated that she thought that less people would go on for a PhD having put all of the extra time and money into the DPT already. Perhaps it could go either way.
This raises another question. What are programs going to make of the newer advanced degrees such as advanced DPT or Dr. SciPT, etc. Will these qualify for academic positions? In some ways...their clincal skills and knowledge will be superior to someone with an academic degree. However, I still think there is something to be said for a person who goes through the rigour of didactic requirements, comprehensive exams, and a dissertation in a non-PT program.
Later,
mcap
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Re: Should DPT's be called "Doctor"? - May 9, 2002 11:08:00 AM
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OSUPT
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mcap,
We actually discussed DPTs in an academic setting while I was still in school, so it's interesting that you bring that up. Our director said that she probably would not hire a DPT as a professor unless that person also had clinical specialist certification (probably similar to hiring MSPTs to teach now?). Not to imply that my school was the end all, be all of PT; just wanted to let you know that there are current PT programs thinking along the same lines you are.
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Re: Should DPT's be called "Doctor"? - May 16, 2002 8:17:00 AM
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julia
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i think they should be definetly called as doctors
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Re: Should DPT's be called "Doctor"? - May 16, 2002 11:09:00 AM
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HillJack
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How about Physical therapy Physician?
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Re: Should DPT's be called "Doctor"? - May 22, 2002 5:46:00 PM
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Andrew M. Ball MS MBA PT
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Personally, I think that DPT's should be called doctors, just like OD's, DVM's, DDS's.
On the other hand, what makes OD's, DVM's, DDS's, etc. clinical doctoring professions is a language of thier own, and the reality that people will go to an OD to get glasses, a DVM for their sick dog, or a DDS to fill a cavity --- regardless of whether or not insurance will pay. The same cannot be said for the DPT --- as such, it just looks silly, like we're trying to "play doctor." The scope of practice for a DPT, afterall, isn't any different than someone with a certificate in PT.
Also, if we call our entry-level "doctor," then what should we call those increasing few in our profession with advanced clinical doctorates in physical therapy (DScPT)? Supertherapist? Physiotherapeutic Physician? God of all that is neuromusculoskeletal?
Finally, as someone who spent 4 years sweating through an academic doctorate, it irritates me a little bit that a DPT, with a mere two more classes over my education, added to their program (imaging and differential diagnosis) would call themselves doctor --- and then brainwash themselves into thinking of themselves as having a doctorate, "just like a Ph.D."
If you want to be a doctor, get a Ph.D, EdD, DrPH, etc. and do some research that contributes the the profession. It seems to me that many students in schools right now want the respect that the term "doctor" commands without really doing the time or gaining the appropriate knowledge.
Isn't it funny that the courses added to most entry-level clinical doctorate programs ARE NOT clinical courses? Shouldn't EVERY DPT student come out of school NDT, SI, and McKenzie certified?
Drew
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Re: Should DPT's be called "Doctor"? - May 23, 2002 3:24:00 PM
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swoodard23
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I know many people pay out of pocket to visit chiropractors. With direct access, do no individuals pay out of pocket to see PT's? I believe PT's usually charge more but I may be wrong.
Thanks,
Scott
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Re: Should DPT's be called "Doctor"? - May 23, 2002 5:09:00 PM
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Diane
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I personally know several PTs scattered throughout the US who have cash practices. These PTs, and the Canadian ones, are a bit of an informal club of sorts...
People will definitely pay cash for PT, the good manual therapy sort of PT, from those who have developed clinical reasoning skills, continue to study and learn, are willing to take time to listen to people and treat them hands-on for extended periods of time, and who have decided that they are tired of a sea of paperwork and billings and beaurocracy.
PTs like this do quite well outside the system. They keep their day jobs, build their practices slowly and carefully by doing great work and getting referrals by word-of-mouth. At some point they go to part time at the day job, because their private cash practice has fluffed up enough. Eventually it pays well enough for them to go completely over to cash, and it's bye-bye headaches. Usual time frame, about a year.
It may come as a shock to some, but patients actually don't care if PTs become doctors or not. They're looking for help from a trained pair of hands and eyes, and a brain that has freed itself into a thinking mind. Only PTs seem to care what we are called.
Diane
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Re: Should DPT's be called "Doctor"? - May 24, 2002 10:11:00 AM
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anOHPT
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Bournephysio,
Sorry, I've been away for awhile.
I see the points you make regarding my earlier comments.
However, What I was driving at was the act of diaganosing- "You have 'X'". I have no problem with the idea of seeing musculoskeletal cases before, or in lieu of, a physician. I just am concerned about being exposed to the enormous liability of missing something that I have neither the skills or the equipment at my disposal to detect.
There was an article on a news site recently about OB-GYN's in Mississippi. Because of the nature of tort law in that state, OB's are getting sued for absurd amounts over sometimes ridiculous claims. Malpractice insurance for them runs $100,000 +, IF they can get it.
As litigous as this society is, I do not want my neck endangered at all.
I believe that the DPT represents a step into territory where we as a profession don't belong.
And, Mr. Ball, you answered the whole question most succinctly- Why should someone who has "a couple more classes" over their M(S)PT program be called doctor when you have rightfully earned the title through years of study, effort and sacrifice?
Let's have specialty certifications, every student coming out should have certification in some form of practice. I would like to see an industrial rehab specialty certification.
Just don't call me doctor.
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Re: Should DPT's be called "Doctor"? - May 27, 2002 4:47:00 AM
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Mark Hirsch
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Comrade Drew [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
the scope of practice isnt any different for PT's with or without a Doctorate? DPT's write a dissertation don't they? Are they awarded a Doctorate? If so, they are entitled to add that title to their name, or is there a law against that?
I don't understand what all the fuss is about.
Mark
Errrr....coming out of school NDT, SI certified...that would be a waste of certifaction unless they are also certified in forced-use, treadmill training with partial body weight support, hippotherapy certified (perhaps) rhythmic acoustic stimulation certified etc etc.
[This message has been edited by Mark Hirsch (edited May 27, 2002).]
[This message has been edited by Mark Hirsch (edited May 27, 2002).]
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Re: Should DPT's be called "Doctor"? - May 27, 2002 6:50:00 AM
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Andrew M. Ball MS MBA PT
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Howdee Marc,
At present, the SOP isn't any different for someone with a BS in PT or a DPT in PT. I suspect that will change in about 10 to 15 years or so though. DPT's DO NOT write a dissertation, although they do complete a "research project," as most of these projects aren't independent, and often simply flow along with whatever the faculty-guided projects from the previous year happened to have been, they hardly qualify as a thesis.
My point is that the DPT, like an OD or DDS, is supposed to be filled with expertise in CLINICAL topics (like filling a perscription or cavity, etc.). The DPT's, to be comparable, would have to focus upon expertise in what we do clinically (evidence-based or not) as well as that which is seldom-used but evidence based. And there in is the point:
NDT and SI are "certifiable," while PWB-GT, and CIMT, etc. aren't. We should expect clinical expertise in ALL areas from a DPT (which is a CLINICAL, not a RESEARCH degree) graduate wouldn't you think? Such simply isn't the case. As a result, I belive that in this regard, even the best of DPT programs, such as Duke, USC, etc. have failed students miserably.
Their education certainly doesn't justify calling oneself "doctor" by the standards of a academic doctorate, and arguably is incomplete in terms of clinical expertise as well.
Drew
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Re: Should DPT's be called "Doctor"? - May 27, 2002 9:06:00 AM
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Mark Hirsch
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Hmmm, I was not aware that in this country (USA) one could be awarded a doctorate from an accredited institution without at least writing a dissertation, passing comprehensive written and oral exams and the defense. That changes the picture a bit -- DPT's should write dissertations and then all would be forgiven. [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG] I see your point Drew. Cheers. Mark
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Re: Should DPT's be called "Doctor"? - May 27, 2002 9:13:00 AM
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Andrew M. Ball MS MBA PT
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I'm not sure I agree with that either. Dentists, Optomotrists, Veterinarians, Pharmacists, and Chiropractors all refer to themselves as Clinical Doctors. Most refer to themselves as a "physician" of one sort or another --- the completion of a dissertation does not a clinical doctor make --- but if not a dissertation, than expert clincal practice and technique upon graduation should be expected.
DPT's don't have this.
Drew
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Re: Should DPT's be called "Doctor"? - May 28, 2002 3:47:00 AM
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Mark Hirsch
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I could legally purchase an academic Doctorate from a non accredited institution on the internet. Does that entitle me to be called Doctor? Heck yes!
Well, in Germany a person graduating from a medical school is entitled to be called Doctor but can't legally place the Dr. in front of their name unless they have written a dissertation. There is no coursework required to write the dissertation (like there is for a Ph.D. in the USA). As a matter of fact, in Germany the Doctorate is not tied to coursework at all - but a series of scientific studies which culminate with the writing of a thesis. In the Netherlands its similar for the Ph.D. student -- the writing of a thesis booklet consisting of a collection of studies he/she performed while a doctoral student.
In my opinion, it's not the title people should respect but the person, knowledge and "character". Mark
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Re: Should DPT's be called "Doctor"? - June 10, 2002 4:44:00 PM
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grfn74
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I am a second year DPT student and have gained insight into many of the intricacies of PT, clinically, scholastically, politically, and from an economic standpoint. I would like to thank those who have posted many of the excellent questions on this forum, it shows that there still is heart when it seems many are losing faith in PT. Some of the replies I read make me fear working in a setting where some seem to have lost touch with what PT is about; simply helping another person get better. As far as the DPT being called DR, I could really care less. I had the option of attaining my BS, or my DPT, and I felt that I would be a better clinician with what the DPT had to offer, so I could help people more effectively. Its a mind-set...be the best you can be, and education is never wasted. Compared to the BS class I could have entered, I will have much more depth to certain areas, although in the curriculum they are listed as the same thing as a MPT, or BS class, but the amount of hours and depth you can gain are at a higher level. I do not want to, not beleive that DPT is equal to a physician, but we are learning at a clinical doctorate level. DPT does not equal phd nor MD. Just what it is, a step past mpt,reflecting the ever expanding amount of knowledge that TODAYS PT should know. Its all about the pt, not the politics. Am I better prepared than a student who just graduated with a BS or MPT, or MsPT, maybe, maybe not. Who cares though, I want the best education so I can be the best I can be, and turn that into results with my future, and present pt's. Thought I'd add my 2 cents.
J
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