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Re: Eating my words . . .
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Re: Eating my words . . . - November 9, 2002 12:53:00 PM
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rcptmt
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that makes some sense........how about this so i can get a glimpse of where you are coming from..........lets say i am a new grad DPT + some previous clinical experience as a loser regular PT(just kidding)........i am able to get a group of orthopedic surgeons, neurologists, and primary care practicioners together for an inservice.........what exactly do i tell them i can do for their patients, that i could not do before my DPT? feel free to use real world examples, such as.....take a neck patient with radiculopathy ......goes to family doc, gets drugs, lab tests, xrays,,,,,,, often referred to neuro,,,,gets EMG, NCV, MRI, more drugs, then referred to ortho/neuro surgeon, has surgery, or not ...gets more drugs. now, i know that in todays world, somewhere along the line, perhaps everywhere down the line, this patient would have been referred to a regular old PT. Where would the DPT fit in?
in addition ....when speaking with this group of docs, what sort of business realtionship do you envision?
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Re: Eating my words . . . - November 9, 2002 1:47:00 PM
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Andrew M. Ball PT PhD
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Joined: July 28, 2002
From: Charlotte, NC
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I suggest spending some time in a private practice opthamology clinic where OD's and MD's work side by side. It will give you a sense of the business model that I envision.
What I'm about to give up by answering your question, however, is several thousand dollars worth of consulting advice --- use it wisely. Just another benefit of being a RehabEdge.com member. So let's keep this between RehabEdge.com members okay?
Having worked for an opthamology practice in my former professional life, I'd suggest a model like the one they tend to use. A patient comes in for thier visit and is initially seen by the OD who takes the history, and takes a few objective measurements. On occastion a quick assessment statement is made in the chart, and then the OD moves along to their next patient.
The MD then comes in to see the patient.
What this model does is allow for the MD to see a greater volume of patients, and in so doing generate increased potential for surgical cases per clinic day --- which is where the real money is. The DPT could also assume responsibility for follow-up care and rehab on the MD's surgical days. Although a BSPT may be able to work in such a capacity, the DPT has the ability to read radiographs and perform differential medical diagnosis --- which may make for a more comfortable hiring choice for the MD.
DPT's are certainly well positioned and trained to assume a similar role for MD's as they can certainly be the "OD" for the neurologists and orthopedic surgerons as we can save the MD the time of taking the history, MMT, nerve integrity testing (and for those DPT's who have been so trained) screening the x-ray for anything significant and condcting a medical screening as to filter those patients who have come to the specialist with medical problems not appropriate for the MD --- thereby saving time and money. Those BSPT's who repeat that the DPT is a waste of time and that they don't need imaging or diff. med Dx skills are missing the point, and a MAJOR future niche, of future physical therapy practice.
Why use a DPT? They're better trained than an RN, NP, or DC for that purpose, and don't cost any more than the providers currently being used, especially considering the revenue that can be generated independently during follow-up care and post-surgical rehabilitation.
Is the happening in practice? Certainly. In fact, I have an interview with a DPM practice in a few weeks.
Drew
[This message has been edited by Andrew M. Ball PT PhD (edited November 09, 2002).]
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Re: Eating my words . . . - November 9, 2002 7:44:00 PM
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johnjfraser
Posts: 102
Joined: June 11, 2000
From: Staten Island, NY
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[QUOTE]Originally posted by BackTalk:
From what I’m reading it sounds like the DPT is going to be the MD’s little bitch. That is “Mommy may I” all the way!
I’m tired of reading the BS that the DPT is some how superior to all other clinical doctoring professions, and especially superior to chiropractors. BS! Are DPT trained in full body diagnosis? Can they perform physical exams for athletes, or school or pre-employment physicals? What about DOT physicals? I don’t think you can, because you, along with DPT, don’t have the training to do so. With that in mind, how does that make your DPT superior to a chiropractic physician? Also, I didn’t make that title up, as it is rightfully granted to doctors who process the knowledge to use it. The impression that this title is “self-anointing” is a crock of **** and merely an act of jealousy, which will get you nowhere. [/QUOTE]
Ouch,
Drew struck a nerve. Frankly Backtalk, any credibility you may have had in this discussion has quickly eroded, especially in a multiple disciplinary exchange. If you are a professional, please act like one.
Is the DPT the direction my profession needs to progress in; absolutely. Will the courses offered in DPT programs give the tools a PT needs to recognize s/sx that fall outside of our practice and refer to the appropriate practitioner, yes. Will the DPT make us into Medical Doctors. No. And I dont want to be a MD, or I would have went to med school. Do I see PT as an access point into the medical system; yes.
Drew has the right idea, PTs doing what they do best working in collaboration with, and not as perceived subordinates to, other health care practitioners. A team of practitioners working toward a goal of making their pts well, and getting appropriate reimbursement for the services provided.
As for your attack regarding superiority, I dont think that is what Drew was trying portray. Unfortunately there are chiropractors practicing with a delusion that they can treat medical problems with manipulation and herbs. These so called "chiropractic physicians" are discrediting any good the good chiros are doing out there. This is why the medical establishment is reluctant in integrating chiro into the mainstream.
As for the exchange among my colleagues in the PT profession: I have been monitoring this discussion on the sidelines, and I have heard enough. Will the progression to the DPT further our profession, and improve the quality of care of our patients, I think so. Nothing is substitute for experience, but the added education will give the PT a "bigger toolbox" to use earlier in practice. Public perception will change with the name "Doctor": (eg; Russion immigrants perception of PTs as doctors based on education in the old country). As for the PTs who disagree and are not sold; keep doing what you are doing at your current education level. But be a reflective practitioner, and cont to grow with cont ed. But dont be counter-productive toward where this profession needs to go. If you are threatened by this change, maybe you should improve on your inadequacies, work on your weak points to make yourself a better practitioner.
Let the following be instilled onto the naysayers' brains, "Lead, Follow, or GET OUT OF OUR WAY!"
------------------
John J Fraser, PT, MS
johnjfraser@yahoo.com
[URL=http://www.geocities.com/johnjfraser]http://www.geocities.com/johnjfraser[/URL]
[This message has been edited by johnjfraser (edited November 10, 2002).]
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Re: Eating my words . . . - November 9, 2002 9:16:00 PM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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Backtalk,
I’m not saying that the DPT is superior to all other clinical doctors, but the reality is that it will have more opportunity in healthcare than the DC. MD's have a higher level of respect for BSPT's than DC's. That's just the way it is. Sometimes it's justified, sometimes it's not --- but that is the reality of the American healthcare system. DC's have just about as much respect among MD's as massage therapists. Not even the columnists at ChiroWeb.com argue that point.
I wouldn't use the word "superior," but the reality is that the DPT will have instant opportunity and greater respect within mainstream healthcare than DC's are ever going to have. With the exception of the way that the APTA turned their back on the AMA in 1985, PT's have generally played nice with MD's. DC's never have --- and the AMA holds grudges. DC's may chant that they're going to be able to overthrow the medical establishment, but no one other than the most extreme of brainwashed chiropractors really believe that.
To answer your questions about the DPT, your premise is all false. The DPT IS trained in full body diagnosis. The DPT CAN perform physical examinations for athletes (in fact, most competent PT’s can do that now), and DPT’s can OF COURSE perform school and/or pre-employment physicals. Although many chiropractors THINK they can do these things with skill, I’ve not found many to be terribly competent in this regard. In fact, failure to even offer training in differential diagnosis was one of the reasons that Life University (which, unless I’m misinformed, has graduated more DC’s than any other program), lost it’s CCE accreditation. I'm sorry if I'm hitting a nerve if you're a Life graduate of the '90's, but that's YOUR comission telling recent Life grads that they've been thrown a bone to have been licensed in the first place. It's YOUR comission that's saying that the ability of a Life graduate to perform in the manner you describe is either seriously lacking, or alltogether nonexistent. That's the opinion of your comission on education . . . I just happen to agree. I sure wouldn't have gone to a DC for my back if I hadn't performed my own differential diagnosis or had an MD, NP, or PA do it for me. There are some DPT's that are skilled in this regard, but I'll admit, not all are.
As most DC's in the field are either Palmer or Life grads, it is my opinion that most chiropractors don’t have the training to act in the glorious manner your describe. It is the opinion of the medical establishment, that chiropractors don’t have the training to do so. It is certainly the opinion of CCE that Life graduates don’t have the training to do so. It is in that respect, given the bad blood between DC's and mainstream healthcare; the extensive training of DPT's in Dif. Dx, imaging, pharm, etc.; and (according to CCE) the breakdown of the chiropractic education of Life graduates in that respect that I without hesitation view most DPT degrees as superior to most DC degrees. I’m apparently in good company.
As for the whole “chiropractic physician” thing, show me where a non-chiropractor bestowed that name upon the profession. You can’t. Why? Because the profession of chiropractic self-anointed itself. Who other than a chiropractor refers to a DC as a “chiropractic physician,” without it being the butt of a joke? Come on Anthony, I’ll give you your due respect as a colleague, but if you think for one second that “chiropractic physician” is a term taken seriously by anyone outside of chiropractic, you’re in serious need of deprogramming from the cult of chiropractic (AKA Church of Chiropractic).
It’s the fad nowadays. ODs are Optometric physicians, DDSs are dental physicians, PharmDs are pharmaceutical physicians, DCs are chiropractic physician, DPM’s are podiatric physicians, DVMs are veterinary physicians, and to some, DPTs are physiotherapeutic physicians . . . whatever. These professions can self-anoint themselves all they want, doesn’t make it deserved. Some non-medical clinical doctors have more of a right than others, but among the clinical doctors, DC’s seem to push it hardest and in my opinion, are the least deserving. Doctor, yes. Physician???? --- (giggle).
Having completed both an entry-level clinical degree and a Ph.D., I must admit that anyone other than a Ph.D., MD, DO, Ed.D., or DrPH calling themselves “doctor” makes me twitch --- but that’s just my bias, and I understand it’s unfair.
Doctor, okay. I can live with that for non-medical clinical doctors, but physician? Puh-lease!
[This message has been edited by Andrew M. Ball PT PhD (edited November 10, 2002).]
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Re: Eating my words . . . - November 10, 2002 6:51:00 AM
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rcptmt
Posts: 21
Joined: July 19, 2002
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warning, .........sarcasm ahead......drew i just paid you 5 grand for you to tell me to be employed by a doctor.....just kidding, i can see where you are coming froom, but i also see where SJ has a point about PAs and NPs already filling that role.......perhaps a poll on the MD DO's would be appropriate to gauge their feelings on the subject, since your model is a collaborative one...........but personally, any model that dooes not include true direct access, again meaning ins pays without referral, seems useless to me.
john..i dont really see how engaging in debate and dialogue on ones profession could be considered counter - productive. Between the PT's here, there is a difference of opinion, i personally have learned from these exchanges. I have gone fRom ******* the DPT and all who worship it....to..... i really dont think its necessary, but i like to hear the opinion of those who do.......I am not ready to concede that the view expressed by john and drew are right/necessary for the profession, although i admire their commitment. You may consider the DPT the inevitable future of the profession, but it will take many years of this kind of debate to make it a reality.
perhaps the APTA sums it up best>>>>>>>>>
on their website they have several qurestion concerning the DPT and it is stated that although the house of delegates approved vision 2020 that included DPT....the APTA has no formal policy........ and it goes on to further elaborate on pretty much the same debate we have here......some think its the future, some dont.
so perhaps we just need to agree to disagree ....but dont expect hoards of PTs out there to allow you to "lead" the profession in a direction that does not make sense to them. perhaps it is we who shall lead you.
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Re: Eating my words . . . - November 10, 2002 7:37:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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SJ,
Your inability to think beyond what insurance will pay for has been well established, as has your fixation on maintaining yourself as having equal training to a DPT despite 2 years of professional training to an MPT's 2 to 3, an MSPT's 3 to 3.5, or a DPT's 3 to 3.5.
I'm not going in circles with you again on any of these points.
Drew
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Re: Eating my words . . . - November 10, 2002 7:40:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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Here's another reason to get a DPT:
You can't do a post-doctoral clinical fellowship without one . . . Of the DPT's about to graduate from Duke, all but a handful are considering a Ph.D. or DScPT, or post-doctoral fellowship upon graduation. A BSPT, MPT, or MSPT wouldn't even be considered for a post-doc.
Drew
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Re: Eating my words . . . - November 10, 2002 7:52:00 AM
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johnjfraser
Posts: 102
Joined: June 11, 2000
From: Staten Island, NY
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RC,
I am not saying debating about an issue is a bad thing. I thing that when someone puts down the progress and the vision of their profession and discourages other people that are considering going back for the DPT, it is counterproductive. The choice of a PT to not progress is their own discretion and business. Hopefully they are doing their part in other ways to foster the profession, like being part of local grassroot efforts and being members of their professional organization (which is representing the interest of the practitioner).
------------------
John J Fraser, PT, MS
johnjfraser@yahoo.com
[URL=http://www.geocities.com/johnjfraser]http://www.geocities.com/johnjfraser[/URL]
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Re: Eating my words . . . - November 10, 2002 9:40:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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RC,
Perhaps I did suggest that we become "employees" of MD's. I see it more along the lines of associates.
Financially, why is that a bad thing? Would you rather have an income of 60% of a practice with a $100,000 annual cash flow, or 20% of one that had an annual cash flow of tens of millions of dollars?
Drew
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Re: Eating my words . . . - November 10, 2002 10:03:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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SJ,
In five to ten years in the future, 80% of the profession will be DPT or DScPT. At that time, when legislators return back to physical therapy negotiators that they're willing to allow PT's to act and be reimbursed as PT's in the miliary, but that only clinical doctors can have imaging, primary care (with insurance reimbursement), and limited prespcription rights . . . do you really think the DPT's are going to keep the interests of the BSPT in mind and say, "No, we know that we spent time, energy, and money, upgrading our skills in these areas with respect to BSPT's and MPT's . . . but we wouldn't want to offend the 20% of PT's who are nearing retirement?!?!?!"
Of course not. BSPT's and MPT's will be hung out to dry so fast their heads will spin. DPT's will experience all of these rights and non DPT's will, by comparison, feel their place and respect within healthcare become narrower than an armrest on a Southwest airlines flight.
I appreciate your practice act argument, but there isn't an alternative --- a profession can't ask for an expended (on in this case more appropraite and complete) practice scope before upgrading their formal education to do so. Well, chiropractors did and from a marketing point of view, it has been the justification behind many MD's, DO's, and PT's dismissing their profession entirely. Are you suggesting we go that route?
Your cyclical argument in this respect, and me NOT having a DPT in my own right, it is the same one that I use. It's nothing more than an ego defense, for either of us. I'm just willing to admit that. I made the choice to complete a Ph.D. so as to be able to get out of clinical work alltogether by that time, but if you plan on being a clinician in 10 years without a DPT . . . you're going to have problems, and more from within your profession than without.
If, however, you don't plan on being a PT by then, then you're right --- the costs outweigh the benefits, and I respect you for making that choice for yourself. To proclaim to others that the DPT is just a PT with a doctor in front is not only wrong, it's insulting to those with the formal education that you and I are both lacking, and it erodes the ability of the profession to progress.
Make whatever professional decision you wish, but I won't allow for you to trash the DPT vision for the sole purpose of protecing your professional ego. Either live with your decision, or do something about it.
Drew
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Re: Eating my words . . . - November 10, 2002 12:24:00 PM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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SJ,
I love it when you try to school me on the future of the DPT based upon your esoteric feelings that are somehow, in your mind, supposed to outweigh basic managerial finance and economic calculations. The repeated exercise in futility, frankly, bores me --- and I'm not going through this with you again.
I'm not going to get into this with you again, but for the benefit of other RehabEdge.com members considering the DPT, I will explain my predictions further, and in greater detail than wishful thinking or vibes.
SJ assumes that market saturation moves in a linear manner. That's simply not correct. It frustrates me that I can't make her see the flaw in her logic, but she simply lacks the formal education in business and is unwilling to listen to how I arrived at the calculation. As stubborn as SJ is on the subject, however, I am left wondering whether or not she truly has complete information by which to assess the future need for herself, or any other therapist, for the DPT in the first place. This leaves her screaming from the podium with incomplete information. RehabEdge.com members should realize this before taking her statements to heart, read further, and make your own decision based upon all the facts, not just vibes and feelings. It may not change your personal opinion as to what you want to do, but have all the facts to make a decision on your future --- without being clouded by emotion.
There is but one point that SJ and I both agree in all of this . . . the climate will change over time. A current PT's position relative to competitors, buyers, and suppliers is dynamic, not static. Furthermore, I will concede that DPT's must be prepared for the fact that even with the best of pre-planning and market research, introduction of this new product (e.g. DPT) or service line does not guarantee demand. Cerntainly not in the short-term, and perhaps not even in the long-term. Perhpas my vision is wrong, but her statements, on the other hand, harm the profession in my opinion.
She's right to think that the DPT may impode upon itself. After all, as I learned in MBA school, some executive at Pepsi in the early 1990’s thought, after reviewing extensive market research, that Pepsi Clear would be a good idea . . . instead it turned out to be perhaps the single most significant miscalculation of consumer demand in the company’s history. The product was horrible, and tasted like licking stamps. The DPT may turn out the same way, but I seriously doubt it. For her you to say otherwise, in my opinion, is simply ego-protecting wishful thinking on her part.
As stated by Shenkman, “Decision makers have to assume that there is no market for the product until the enablement is established as a preferred way of doing things with a wide segment of the population. Thus, the business [e.g. the profession of physical therapy] has to promote changes that support this enablement." SJ's statements to date are counterproductive to that reality. Will she be happy if the DPT fails to revitalize the profession because PT's like herself trash it in open forum? I say that if it fails to meet it's potential, it's not the fault of the APTA, nor the DPT, it's the fault of the DPT's seasoned colleagues, like SJ and most PT's with more than 10 to 15 years of experience, who cut them off at the knees. Ironically, it will be these very PT's who, when and if the DPT concept fails, will scream, "I told you so!"
The dynamic nature of the healthcare environment dictates that consumers/patients/and referring physicians will continuously re-assess and re-deploy resources allocated to meet individual needs, which I belive will eventually mean, if given a choice, DPT over a BSPT or MPT in every instance. In the final analysis, competition takes place in the healthcare environment as primary care physicians make choices designed to enhance the nature and quality of patient care though the most efficient and cost-effective means possible --- or failing that, the assumption thereof based upon higher degree. There is no debate on that point.
SJ may charge that my estimations are optomistic, but by my math, they are actually quite conservative. Getting back to her 18 year timeline it is hoped that the vision will be realized BY 2020, not IN 2020. The following is simplified MBA stuff not taught in PT school, but not easy to follow in text. If you the reader have kept up so far, try to keep up, and feel free (anyone on the site) to ask for me further explain if it's not understood:
What SJ, and most PT's without business training, fail to realize is that market forces do not react in a straight, liner line. They will resist the introduction of a new product (e.g. the DPT) until market saturation reaches 20%, at which time market saturation explodes at mind-blowing speed. There are already several thousand DPT's in the field, and about half of all PT programs will graduate at the DPT level within two years, that's, starting in 2005, 3000 DPT graduates per year. Assuming that no additional schools make the DPT conversion (which is highly unlikely), 20% market saturation (28,000 of the ~140,000 PT's in the US) by 2015 is highly likely as ~100 of the PT schools graduate 30 DPT's each year, on average, over the next 10 years --- if not before that time. Considering that there are already several thousand DPT's in the field, AND that it's likely that more and more PT schools will go DPT in the years 2005 to 2010, 20% market saturation is likely to be reached by 2010, if not earlier (2007 at the earliest) --- which is a 5 year, not 19 year timeline.
So that's 20% DPT by 2007/2008, and 80% DPT by 2012/2013. You heard it here first on RehabEdge.com folks, quote me on that if you like.
2007/2008 will be the point of general acceptance and explosion. That's when most non DPT's in the field will break down and get a DPT. By 2015, at the latest, 80% of PT's will be DPT's. Interestingly, those 20% that are still not DPT's by that time will NEVER consider getting a DPT. Transitional DPT programs will shut down at or before that time due to lack of students. Non DPT holding PT's will live out their lives believing that the DPT is not necessary. Some will be right to have not gone the DPT path, some will be wrong and self-lothing for not having gone the pat, but either way, I have no doubt that SJ will be in that 20%. Will she be in the happy bunch or the bitter bunch? Who knows? Who cares. The question is, reader, what is right for you?
The future is clear. It's basic economic theory, and has proven itself in several other emerging clinical doctoring professions such as PharmD and AUD. PT to DPT won't be any different. How will you position yourself to take advantage?
Drew
[This message has been edited by Andrew M. Ball PT PhD (edited November 10, 2002).]
[This message has been edited by Andrew M. Ball PT PhD (edited November 10, 2002).]
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Re: Eating my words . . . - November 10, 2002 2:56:00 PM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
Status: offline
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You're missing the point. I'm not calling you anything other than emotional, and I'm not debating this with you any further.
I've stated my points quite clearly.
Drew
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Re: Eating my words . . . - November 10, 2002 6:17:00 PM
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Sebastian Asselbergs
Posts: 1205
Joined: September 29, 1999
From: Barrie, Canada
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Drew, you have stated your points clearly. I also thought that SJ did the same thing. After spending a lot of time reading the exchange between the two of you (and others), I could not help but think of the time when here in Ontario the education for a PT went from a 4 year programme to a 7/8 year double degree level. For a "mere" Diplomate in PT like me, this was expected to have significance. It did not.
I am still a "direct access" practitioner.
I won't go on too long, but I am impressed with SJ's restraint, and with your rather condescending style. I find it sad that just as some interesting stuff from the APTA shows up, you get quiet....
IMO, DPT will have some benefit in the future for the PT. Is it as big as you say it will be? No-one knows; I do not think so.
Sebastian
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