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Re: Chiropractic vs PT as a profession-
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Re: Chiropractic vs PT as a profession- - October 5, 2003 7:21:00 PM
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mcap56
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The residencies, as outlined above do sound like a really good idea and I think it would be a way to increase standards, scope of practice and expertise. The residency programs people complete now are usually in very specific, very specialized areas. Something a little closer to the medical model would be an improvement.
One obstacle would be the PTs desire to choose from a variety of areas. Most are not ready to commit after school and many like the option of switching areas fairly easily. With a residency/exam requirement, this wouldn't be as easy. But perhaps it shouldn't be.
Another is, of course, money!! I don't know how the economics of residencies work out for hospitals. Do they get paid for graduate medical training? Do they get medicare funding? Is it tied to the care they give for the uninsured? How would it work in PT?
Don't think it's likely to happen, so for now.....it's all conjecture.
mcap
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Re: Chiropractic vs PT as a profession- - October 5, 2003 7:32:00 PM
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Dr.Wagner
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Of course it is purely conjecture...
And yes residents get paid, roughly 40k each year of residency and 3-5% increase per year until completion. Medical residents of course work 80 hours a week and are TOTALLY ENGULFED in medicine and the care of the patient, something PT certainly is not ready for (hell I remember everyone bitching about working half a day on saturday!)...PT is a wonderful lifestyle and relatively easy to live day to day, few stressors except for those in private practice. But a six month internship is certainly possible, and easy.
Hell, it won't happen, there are relatively few Pharmacy internships out there (I kinda snicker when they talk about their "tough residency"...not alot to it no patient care and no more than 40 hours a week, but it helps provide specialization in the ICU, Oncology etc). But I certainly would help add credibility to the profession...especially with direct comparison to chiropractic.
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Re: Chiropractic vs PT as a profession- - October 5, 2003 9:10:00 PM
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Sam B
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Dr Wagner,
What would be the best environment for this type of residency? I know that a lot of Orthopedists train in a specific private outpatient clinic accredited as a residency site, but performing surgeries in a hospital nearby. I wonder who would pay the salary of the P.T, the private clinic or the hospital?
I think internship is a wonderful idea. The residency faculty would have to be combined MD/DO and PT , to give it backing from the medical community. Would your fellow physicians think that an MD/DO involved with this would be "selling out" their profession to PT's? ( I imagine that medicine is so firmly established, that PT's training under MD's would not be a problem?)
Yes, asking PT's to work like a dog would be a paradigm shift, but there are those out there ( myself included) that will do just about anything to be super competent. They set the standards and inspire others to follow (well, that has been the history to date in the PT profession) I think an internship would allow a better relationship between MD's/ DO's and PT's....maybe we get to inject trigger points, read x-rays, EMG's etc, kind of like a P.A, with physician communication/interaction, but autonomy to practice PT that is "non medical" with treatment that is firmly within our scope of practice. I know this sounds like a PT physician extender, but that is not what I am getting at. I am talking about advancement of PT's as indispensible to the public and physicians; responsible/ knowledgeable,and careful port of entry clinicians, with quick/open communication with allied physicians?
Sam
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Re: Chiropractic vs PT as a profession- - October 6, 2003 3:43:00 AM
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Dr.Wagner
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The vast majority of residencies are university based...the rest are private hospital based with a much larger ratio of surgical/on call time to clinic time (rounding on patients during the day, getting in on surgeries the rest of the day)...orthopedic residents are not committed to a single orthopod, rather a group.
No MD/DO would consider it selling out because it is a different profession all together...there isn't a whole lot of utility in following a Doc all day for a month simply because it really doesn't offer alot of transferral of skill to the PT (i mean, you don't suture, inject, perform surgery, do consults, etc). Reading xrays is a nice skill, but unless you do it EVERY DAY it is lost, and there is huge liability (yeah they are read by a radiologist later, but if you "mis-read" one, then Physician quality assurance points it out over and over to you...and Fractures are the number 2 reason for lawsuits in Emergency Medicine.)
I think the key is an internship 90% based with a therapist. Hell, I wouldn't mind a PT following me for a day in the ED (I see alot of orthopedic injuries and a ton of differential diagnosis), but likely it would only cause a ton of doubt in a PT's mind because most of the complaints I get are viceral-somatic referrals (ie neck pain that is something else completely yadda yadda, )
Speaking of which, did you guys read the article in Advance for PT regarding "Lightheadedness"?? Terribly written.
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Re: Chiropractic vs PT as a profession- - October 6, 2003 7:26:00 AM
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mcap56
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My questions were related to payments to hospitals, not individuals.
Again, it all sounds like a very good idea. Too bad the opportunity was missed.
ncao
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Re: Chiropractic vs PT as a profession- - October 6, 2003 7:42:00 AM
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touchiba
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I could be wrong, but why put a PT through a residency to perform the same services as a physiatrist?
For those that are super motivated and want to work with physical modalities and needling and diagnosis, become a physiatrist, right?
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Re: Chiropractic vs PT as a profession- - October 6, 2003 9:36:00 AM
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Andrew M. Ball PT PhD
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Touch,
You're not wrong, just dated. Your comment is exactly the point of this discussion. Physical therapy, even at the weakest link in the profession today, is more than simply physical modalities --- and has been for more than 20 years. It IS diagnostics, it IS portal-of-entry, it is emerging into imaging as well. We ARE specialists in neuromusculoskeletal diagnostics and treatment, and we ARE trained for medical screening, we DO engage in EMG, NCV, and US diagnostic studies.
That doesn't make us wanna-be physiatrists --- it simply makes us physiotherapists.
Drew
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Re: Chiropractic vs PT as a profession- - October 6, 2003 10:41:00 AM
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Dr.Wagner
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Personally I think Touch has a good point...my point was that PT simply NEEDS more standardized training...I am not saying they need to expand scope, rather lengthen their standard training just to become certified in areas of PT (ie can't work independently in a clinic until completion of 1 year of post graduate training). Drew, sorry but that is not at ALL what I am talking about...not at all.
Touch, what I have been speaking of has nothing to do with physiatry or medical diagnosis and treatment. Residency for physiatry is 3 years plus internship (total of 4)...I am simply speaking of physical therapy internship (focused exercise training, focused manual skills, focused developement of time management...each in the field of the therapists choice). Nothing like physiatry.
The goal is to avoid referring to an outpatient ortho clinic staffed by people who at a whim decided ECF therapy or acute hospital therapy "wasn't for them". It helps the consumer and the Physician better maintain quality assurance.
[This message has been edited by Dr.Wagner (edited October 06, 2003).]
[This message has been edited by Dr.Wagner (edited October 06, 2003).]
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Re: Chiropractic vs PT as a profession- - October 6, 2003 4:04:00 PM
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Matthew Hauger
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I too have no interest in mandatory specialty recidencies. Requiring a PT to choose a specialty right out of school seems overly restrictive to me. But I do think a general recidency that requires collaboration with other professionals (nurses, physician, dieticians, etc) would have been great. Especially in the areas of diferential diagnosis and radiology. You can't be a good PT unless you know what not to treat. The same goes for every health professional.
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Re: Chiropractic vs PT as a profession- - October 6, 2003 4:26:00 PM
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Dr.Wagner
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Well I am not a policy maker of course...my previous discussion was to prevent companies or therapist from one month being in an ECF and in outpatient ortho the next month...it is quality assurance for both the patient and physician referer.
Mandatory internships are FAR more economically feasible than requiring DPT's for everyone! Furthermore, as a referer I don't know the therapist from Adam. Say I refer to Drew, hell, I don't know what his PhD is in, where he got it , how he got it, and in what environment he has spent the last 5 years working. But if there was a mandatory "neuro internship", I could refer to him without hesitation as I would "know" he was up to snuff and passed a national standardized internship and certification exam (therefore eliminating the bias of BS vs MS vs DPT vs PhD). Right now he could have a PhD in Hospital Management or something, and give the wrong impression if he worked in a clinic...sorta like "Dr. Laura" or whatever her name was with a PhD in an unrelated field in which she practiced.
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Re: Chiropractic vs PT as a profession- - October 6, 2003 5:31:00 PM
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Andrew M. Ball PT PhD
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Dr. Wagner,
There are clinical residency programs, the ones in pediatrics neurodevelopmental disabilities, for example, have been around since the Kennedy administration. FYI, I completed mine at University of Rochester in 1996, and it's distressing to note that while the interdisciplinary programs existed for years, that I was one of the first full-time, full-year LEND fellows in physical therapy in the country, and certainly the first at the University of Rochester --- nearly 30 years after the inception of the interdisciplinary program.
I agree with everthing that I think you're getting at. In fact, I've been SCREAMING that the profession made a MAJOR mistake by going to entry-level DPT's instead of completely re-vamping the educational model of physical therapists. My personal favorate is a reset of every entry-level graduate to MPT (yes DPT's, that includes you too), and changing all state practice acts to (like teachers in most states) require post-graduate education within x years, or the professional's license will sunset. The post-graduate education would then be DPT in a specific terminal-doctorate area. The clinical discussions that would take place in the classroom would be FAR more enriched, and the portal-of-entry and diagnostic screening coursework would certainly take on a new life.
Just for clarification, my PhD is in Healthcare Management, but research is research. A PhD in ANY field, be it management, english, or pathomechanics, should NEVER be confused with a clinical doctorate.
My PhD serves primarily as a marketing tool, and I make no bones abouit that. At least in my area, in the few short months that I've been doing neuromusculoskeletal care, I've cornered the market among PT's for clients without physician referal, and for referal from family practice docs and PA's. I'm told that my PhD gives them a level of comfort that my treatments will be more evidence-based and as a result more efficient and effective. Although I tip my hat to my more "experienced" elders, it's clear that the percieved value is that my treatments will be more effective because I actually read the research (this is particularly valued among the MD/PhD's), and that I'm probably not the kind of guy who's wasted years of my life becoming an "expert" in something like facilitated communication (an SLP technique that claimed to be a means for people with severe communication disorders to "speak" through a faciliator would would guide the patient's hand among a Ouja board), which sent parents to prison on the basis of what was later found, by peer-reviewed experimentation, to be BASELESS --- rather an amplification of the facilitator's subconcious.
This is NOT to say that there aren't BSPT's out there that are as current, have had the experience of being a PI on a research grant, can truly dissect good research from bad, and apply valuable information to patient care --- but the perception among MD's is that a PhD should be able to do so as a result of their unique training, and therefore has greater POTENTIAL to be a better clinician. Is this true? I'll let my patients and refering physicians be the judge.
Is it better to be fairly skilled in a technique that works, or an expert in a technique (like craniosacral therapy or strain-counterstrain), that is bogus?
Drew
[This message has been edited by Andrew M. Ball PT PhD (edited October 06, 2003).]
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Re: Chiropractic vs PT as a profession- - October 7, 2003 10:37:00 AM
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Andrew M. Ball PT PhD
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SJ,
I think that while that may be true in urban areas, in rural settings, MD's send to specific PT's because there aren't that many to choose from. For me, that makes it worth the commute out of Charlotte.
Drew
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Re: Chiropractic vs PT as a profession- - October 7, 2003 1:00:00 PM
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Dr.Wagner
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From: Indianapolis
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ONe thing I am NOT for is MORE LETTERS...the PT profession is in LOVE with letters behind their name, personally I think everyone should simply have "PT" behind their name (heck so was I ...I used the CSCS bogus junk too!), I think that referral to a particular clinic (be it ortho, neuro or peds) should be proof enough for specialization! One goes to a pediatrician without the surprise of seeing a doctor trained as a dermatologist correct? Why should that be common place in PT ( of course I am exagerating)? In large companies it is COMMONPLACE for PT's to move from an ECF to outpatient treatment without the referral source realizing this. I certainly do not think this is fair to the patient, therapist or physician referer. My discussion has been to up the standard in PT training...that is by CREATING standards. Do I expect it to happen, nope. But would it add credibility to the profession, yes.
Drew I had no idea your PhD was in Health Management.
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Re: Chiropractic vs PT as a profession- - October 8, 2003 2:55:00 PM
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Dr.Wagner
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Ding ding ding ding!!!
I am trying to make this clear. What I am looking for is a standardized approach to PT education with specialty certification as a standard and not an exception. If you work in an ECF you did a geriatric internship, outpatient ortho the same...so on and so forth. At a company I worked for when I graduated from PT school, they moved therapists from Outpatient rehab to geriatrics and vice versa with great regularity...and this certainly is not an uncommon occurance. I think it is a practice that should cease, and with the "internship" requirement it would add greater credibility to a therapists practice as well as greater re-assurance to the physician and patient.
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Re: Chiropractic vs PT as a profession- - October 9, 2003 4:06:00 AM
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Dr.Wagner
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well yeah, I am also talking about that as well...that is purely a singular example. Many speak about PT's being point of entry providers, yet the standard of education on the post graduate level simply isn't there and it is a shame. And yeah, the quality of educators are simly lacking to realistically go forward with what I propose. Also, 3 mos for transition? I guess that may be ok for you, but I think it actually takes a bit longer to truly understand rehab from setting to setting. While a generalist education may be adequate for ECF rehab, it certainly isn't up to snuff for acute care, ortho, neuro etc. Perhaps I am a bit critical after taking part in graduate and postgraduate medical training and I think that PT should have moved their focus from increasing professional education to focusing on post graduate education (in other words I believe their move was PR rather than truly raising the bar for educational standards of practice). Now we are left with the same situation "should the new grad take this patient independently" or "call in 'so and so' from the ECF, Sue at the ortho/neuro/wound care clinic is sick and we need coverage".
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Re: Chiropractic vs PT as a profession- - October 9, 2003 5:31:00 AM
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mato_tom
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for the larger picture concerning PT education i feel it is at, actually beyond the level it needs to be....the DPT, never mind i dont even want to go there.......i would say that as PT moves more into portal of entry and true direct access, they could make some cont ed requirements on these issues mandatory ,,just like they do with HIV and medical errors.....on the other hand we should have those skills now, knowing what to treat and when to treat it and when to refer out...which is the key as portal of entry ... we do not need to make medical diagnosis.......
on the smaller picture of being confident in where your patients get PT.........how do you know what neurologist or orthopedic to send patients...hopefuly you took the time and effort to get to know them or at least get opinions about them from collegues ,,,why would PT be any different,,,,,i guarantee that if you called 5 local PT clinics and said you were the local ER doc and was looking to refer patients you would have 5 clinic reps taking the time to come see you.....if you are worried about ECF PTs seeing your ortho patients weed out the clinics that do both....if a clinic sends you a office manager with cupcakes instead of the owner PT or lead PT ...cross them off the list........i admire the fact that you are concerned where and how and by who your patients get treated, but, like they say if you want to do it right,(in this case making the correct referral) do it yourself, find the PTs you like and trust .....
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