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Re: Chiropractic vs PT as a profession-
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Re: Chiropractic vs PT as a profession- - October 1, 2003 3:00:00 PM
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Matthew Hauger
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From: Hermitage, PA, United States
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Hi 5327echo, I think Scanner did a pretty good job of pointing out some real differences. I just thought you might be interested in learning about some of the different areas that PTs can work in. Before I went to PT school, I had no idea that we (Not me, of course. I do mostly outpatient orthopaedic) could perform in so many capacities.
Orthopaedics
Sports Medicine
Ergonomics
Pediatrics
Wound Care
Cardiac Rehab
Pulmonary Rehab
Neurological
Balance/Vestibular
Lymphademia treatment
...etc, etc
Each of these are seperate entities. Pediatrics is not just orthopaedic work with kids. Two totally different ball games.
Though there are always exceptions, PTs and Chiros usually just compete in Orthopaedics. And even then, the competition is mostly for back pain. To once again use pediatrics as an example, if you're a PT and you're interviewing for a job in a public school, there's no way in hell that you're competing with a Chiro.
Are there areas of Chiropractic that don't compete with PT? I have no idea.
--Matt
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Re: Chiropractic vs PT as a profession- - October 1, 2003 4:51:00 PM
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tucker
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Just to add onto Matthew's excellent post, I spent half of today debriding necrotic wounds (cutting away dead tissue from wounds)and the other half was spent in the burn unit helping patients regain the ability to walk again after skin grafting. It is an extremely rewarding profession and there are so many areas to specialize in.
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Re: Chiropractic vs PT as a profession- - October 2, 2003 5:02:00 PM
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Dr.Wagner
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I remember not long ago a Trauma Attending telling me that only burn nurses debrided wounds etc...then I told him how I learned debridement in PT school, he was quite amazed. It seems that the practice is purely regional...but it is quite true that PT can be a diverse field!
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Re: Chiropractic vs PT as a profession- - October 3, 2003 5:33:00 AM
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Scanner
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I didn't want to bring up this controversial aspect of chiropractic but nonetheless, it is there and I suppose it presents an opportunity in a career sense.
It is being portrayed here that the only outlet for chiropractic is treating outpatient back pain and whiplash all day long. True, if you have a strict interpretation of the evidence, than that's what you would do - because the scientific evidence is clear for chiropractic in those areas.
But let's look at the different opportunities a chiropractor may have:
1. One DC could "specialize" in pediatrics, taking post graduate diplomate courses and sitting for a board, and treat childhood ear infections employing nutritional advice and spinal adjustments and lymphatic massage.
(There was just a recent media blitz by osteopathy on the Today Show for this treatment and condition)
2. Another DC could have a full rehab type center. One poster here noted he was treating ankle sprains, casting orthotics, etc. In other words, NMS conditions beyond the spine.
3. Some DC's add acupuncture with chiropractic and treat GYN disorders such as dysmennorhea using an integrated approach.
4. Still others may take mainly nutritional approach with their patients, treating digestive disorders such as acid reflex, IBS,
5. Still others, get a diplomate in neurology and treat learning disorders by making simple adjustments where they sit in class, wearing red sunglasses (yeah, really, one of my patient's sons with ADD saw a chiro. neuro. - I don't understand it) or adjusting just the right side to give proprioceptive input to a certain hemisphere of the brain.
The common theme to all of this is - this is all done in private practice.
As you can see ( and I am sure many here will criticize ) it results in a non-standardized approach to a displine, where PT is strongly standardized. But on the positive side, it allows the practicioner an "artistic expression" of his disipline and presents different career opportunities, if you are a good enough businessperson to market it.
So go ahead, fire away at me, but while we are hanging out the laundry, both clean and dirty, I thought I would show everything.
[This message has been edited by Scanner (edited October 03, 2003).]
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Re: Chiropractic vs PT as a profession- - October 3, 2003 7:55:00 AM
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OAK
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Unfortunately, I know of several P.T.s who perform all of those treatments you've described (namely my old boss). They are all within "our" scope of practice and many are covered by provincial funding.
The only "standards" we have to follow is that we are not allowed to call ourselves specialists.
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Re: Chiropractic vs PT as a profession- - October 3, 2003 8:43:00 AM
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mcap56
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Ditto the last poster.
I know of too many PTs who practice similar techniques or others that are equally as suspicious. On the other hand, there is an active movement within the profession to tackle this issue.
mcap
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Re: Chiropractic vs PT as a profession- - October 3, 2003 8:44:00 AM
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Dr.Wagner
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what there probably should be is standardized residencies (not a weekend, not a month but at least a year)for any and all PT's and DC's who wish to practice in a particular area...much like medicine. This is an even better stardardization, and provides a fixed set of hurdles for those who wish to truly be called "specialists".
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Re: Chiropractic vs PT as a profession- - October 3, 2003 9:14:00 AM
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Scanner
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DocWagner:
I agree.
The chiropractic diplomates are pretty intense from what I hear on the didactic front - 1 weekend/month for 3 years often. You become "board eligible" and then take a test to become "board certified." Not everybody passes the test the first go-around. I have spoken to a few of these board certified DC's and they are without a doubt, very intelligent and informed fellows/gals in their area of expertise.
The DACBR speciality (Diplomate of the American Chiropractic Board of Radiology) does have a residency at a chiropractic college. The admission to that program is limited. The other diplomates are just done on the post-grad level. DACBR's often teach radiology courses at chiropractic college.
An interesting note on DACBR's - a study was performed where they placed 30 or so pathologies on x-rays and had DACBR's, medical radiologists, DC's and family docs read them. The most accurate were DACBR's, followed by MD radiologists, DC's and then family docs (makes sense). This, of course, didn't include bone scans, ultrasounds, MRI's, etc.
Point is - it is a very respected speciality in chiropractic.
Another interdisiplinary diplomate that I was interested in for awhile was the AAPM - American Academy of Pain Management. PT's, DC's, MD's, pharmacists, dentists, can all become board certified.
No residency necessary for board certification there.
(Then I just decided to be a vanilla DC ;-) )
However, where I agree with you, it should perhaps be incumbent upon the DC's to set up a fellowship/rotation of sorts within a pediatric practice, a neurology practice, or orthopedic practice vs. just pure didactics in those areas. Even if it is for 6 to 12 weeks.
OAK,
I have never seen or heard of PT's engaging in the above scenarios. Does this happen in the US or other countries?
[This message has been edited by Scanner (edited October 03, 2003).]
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Re: Chiropractic vs PT as a profession- - October 3, 2003 9:20:00 AM
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OAK
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There is some movement towards specialization in PT in such areas as spinal manipulation, sports injuries, neurology and cardio respiratory.
I am all for this movement as I believe it would strengthen our profession. Also, specialization already does exist as many therapists, once established, will work soley within a specific area of practice.
On the other side, some feel that it will create a shortage of Therapists in much needed areas of practice. Others complain that they will be forced to take extra training without receiving any additional compensation.
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Re: Chiropractic vs PT as a profession- - October 3, 2003 9:43:00 AM
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OAK
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Dear Scanner,
These practices are very common where I'm from (Western Canada). I know of a few clinics who solely practice this "alternative" type treatment. They are not very respected by the PT community nonetheless they do quite well.
Most of the treatments are done with accupucture and lasar. There are some done with manual therapy, though. I know of a clinic that uses only the respiratory model of treatment for spinal dysfuctions.
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Re: Chiropractic vs PT as a profession- - October 3, 2003 9:58:00 AM
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mcap56
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I like the residency idea and I think it could add a lot to professional standards. There are two issues that come to mind however.
First, are there currently enough PTs out there with sufficient expertise to supervise the PT residents. Many PTs aren't really even qualified to clinical instructors in my opinion.
Second is length of commitment. I don't think you will get people to go to school for three years and then commit to a residency at current compensation levels. If the quality of clinician improved however, there could be pressure on salaries. But that is hard to predict and depends on many factors other than quality of clinician.
There are a number of residencies in specialty areas currently. Perhaps with standardization and expansion these could help to meet the demand. However, the specialty/board exams are tied into them.
mcap
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Re: Chiropractic vs PT as a profession- - October 3, 2003 9:58:00 AM
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mcap56
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Should have read are NOT tied into the specialty exams.
mcap
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Re: Chiropractic vs PT as a profession- - October 3, 2003 10:27:00 AM
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Sam B
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Full time residencies are available in the U.S. For example, the Ola Grimsby Institute has several instructors who train PT's in Orthopaedic Manual Therapy, while they work full-time in the clinic. The PT "student" ( licensed PT) must be licensed in that particular state. The student receives a regular salary and often can gain many contacts during their stay, for future employment.
The contact hours to become a fellow with the AAOMPT is now very high, indicating a strong move towards more hours during residency/ fellowship training. Sections of the APTA have residencies in Sports Medicine ( Kevin Wilk for example) and the student can work/ learn at the same time. The choice of the instructor depends on who will take students; but from my experience, some of the best clinicians in the world are taking students.
If the residency is accredited by the AAOMPT and the student meets all the requirments, a specialist title is earnt.
I don't know of other residencies in say neurology or pediatrics etc, but that would be equally beneficial. During my residency I can tell you I developed many many grey hairs and the rigors/ standards were exceptionally high.
Sincerely,
Sam
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Re: Chiropractic vs PT as a profession- - October 3, 2003 12:17:00 PM
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OAK
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Where I'm from the University won't support manipulative specialization as it doesn't believe that there is enough "scientific evidence" to support teaching spinal manipulations in school. They further exemplified this by changing the program to Masters and reduced practical teaching requirements.
Also, the orthopedic division of our association doesn't want to lose the revenue that it brings in from manipulation type courses and therfore are against specialization as well.
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Re: Chiropractic vs PT as a profession- - October 3, 2003 2:04:00 PM
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Bournephysio
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OAK, what province are you from? What university are you talking about?
The move to a master's is a political move intended to be closer to the states. It has nothing to do with specialization.
University of Western Ontario has post-professional masters in manual therapy.
The ortho div has no say in the matter any more. CAMT is the IFOMT member association and accredits the manual therapy programs. That being said, as far as I'm aware the orthopaedic division is fully supporting the move to specialization. In fact, I was told by a member of the Pediatric specialization group (or whatever) that the orthopaedic group is light years ahead of the other groups when it comes to specialization.
I have no clue where you are getting your information.
Doug
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Re: Chiropractic vs PT as a profession- - October 3, 2003 2:27:00 PM
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OAK
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Dear Bournephysio,
I'm from Alberta and I sit on the APA board. My understanding was that there was tension between the orthopedic division and the University. If specialization were to occur the two need to reach an agreement.
I feel the decision for Alberta to switch to a masters program is a step in the wrong direction as less "hands on" practice is being taught shifting away from the possibility of a specialty in spinal manipulation.
I believe you are right however, the masters program was motivated by different reasons (reasons which I don't agree with)
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Re: Chiropractic vs PT as a profession- - October 4, 2003 5:55:00 AM
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Dr.Wagner
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What I am speaking of are not "residencies" to learn a particular theory persay, rather to learn an entire specialty(orthopedics or wound care or neuro)...based in as much EBM that can happen... and standard across the board. Personally I have stated that should have been made priority over an entry level DPT degree.
As an employer and referer, I don't care if the therapist is a DPT, MSPT, MPT OR BSPT or PTA...if they ahave the experience and skill that is what matters to me and to my patient. Such standardization is crucial and adds legitimacy to a therapist similar to the standards of MD/DO residency and specialization.
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Re: Chiropractic vs PT as a profession- - October 4, 2003 6:49:00 AM
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Sam B
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Dr W,
Residencies in PT are a strange name, because they really are not residencies at all. They are not full-time for the most part, usually just one day a week over say, 2 years. In the program I did, in the first 2 years we studied one area a month over the first year eg foot, hand, SI, Lumbar, TMJ. Everything related to that area was taught at a higher level than at PT school. We covered anatomy/ pathology/ biomechanics/ histology and physiology...evrything imaginable. The second year was a repeat of the first, but we examined patients with problems in that area eg foot, lumbar etc... who were brought in to the clinic.
Nothing but Orthopaedics for 2 years. At the end of the 2 years, we had a 5 hour written exam, with 4 questions only. An 80% score was required to pass and many did not. If we passed the written exam, then we flew to Utah and sat a practical exam in front of a board of examiners. The exam took about an hour and the student performed evaluation and technique on a "model" with no pathology.
After that 2 years, I did another 2 year program. This was only open to students having passed the first program as described. Nothing but intense/ insane amount of reading research articles on pathology, patho-anatomy, pathomechanics, psychology, histology, radiology, nutrition and advanced evaluation and treatment procedures.
If we then passed another 5 hour written exam, then we fly to Utah and examined a real patient with an unknown diagnosis ( of course, the board of examiners knew that diagnosis!) We had an hour to examine that patient and then present the diagnosis. If the diagnosis was wrong, you failed. A friend of mine failed because he missed a Klippel-Feil disease, another because he missed an alar ligament rupture ( and he proposed the patient have treatment with a C1-2 manip)
After passing those 4 years, I was then eligible to be a fellow of the AAOMPT ( recognized by the APTA)
So, the standards are there and defined already. The APTA is credentialling the AAOMPT programs, as this is where the residencies in Orthopedics are coming from. The APTA does have the "OCS" ( Orthopedic Certified Specialist) program. This, in my opinion should be expanded or changed so that a "specialist" in Orthopedics is required to have much more intense residency training. The OCS is hard to get ( and I know at least 10 PT's with the OCS) but nothing on a residency.
On the flip side, there are MANY PT's who are better than any AAOMPT fellow or OCS PT, but they will be recognized as competent by their patients and from referring physicians that get good results with them. But, the letters after ones name (once standardized )can then be a sign to the public and referring professionals that a level of competency was obtained. Maybe then we can get rid of all the CSCS, SCS, OCS titles and just standardize it all. Its heading there, it'll just take a little time. I don't believe the move to a DPT at the university level will improve speciality skills in Orthopedics or other areas, so residencies will still be needed after getting one's DPT if choosing to specialize and be recognized as a specialist.
Cheers,
Sam
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Re: Chiropractic vs PT as a profession- - October 5, 2003 7:23:00 AM
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Dr.Wagner
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Yes, so essentially what I am speaking of is more of the medical paradigm than the current thinking in PT.
Hey I felt that residencies should have been mandatory practice for PT's when I practiced.
So when I speak of "residency" (which isn't true, considering the term comes from the doctor who lives ie resident in the hospital), I mean a FULL time 40+ hours a week at less than full pay (30k or so) focusing in on ONE particular field...then after that year, testing for certification. So it is more like an internship...but it should be of strict clinical focus, much like medical residencies. It also take away from the gamble of referring to a clinic that may be full of new grads and the Doc not knowing. You could refer to a clinic with true specialist in ortho rehab or neuro rehab...the current standards really HAVE NO standards.
Many speak of the growth and expansion of PT, but really without a requirement for an internship/specialization year, these advanced entry level degrees do nothing to guarantee quality. It has always been said that the residency MAKES the doctor...I think that should be true for PT.
[This message has been edited by Dr.Wagner (edited October 05, 2003).]
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Re: Chiropractic vs PT as a profession- - October 5, 2003 9:31:00 AM
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Sam B
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Ditto that.
I personally would like to see PT's doing rounds with Orthopedists, Neurologists, Internists/ endo ...whatever would be the "purist" source for education of pathology/ clinical states as relates to the specialty field of internship training at a higher level. PT's still have to be PT's, but they can integrate into the medical model with higher levels of training, so that D.O's/ M.D's can know that they are not simply technicians and are part of a team of allied professionals, with different skills and training.
Any ideas/comments on that thought ( more alliance between the professions in PT internship training)?
My best,
Sam
[This message has been edited by Sam B (edited October 05, 2003).]
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