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Re: Chiropractic vs PT as a profession-
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Re: Chiropractic vs PT as a profession- - January 14, 2004 11:42:00 AM
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coloradojulie
Posts: 413
Joined: November 10, 2002
From: colorado usa
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I am on Doc Wagner's side here. Objectively there is absolutely no comparison between educational requirements. We have an ortho surgeon here who used to be a chiro and he has openly compared his limited prior knowledge base to his current. He still uses chiro services (PT more) but is strongly aware of how much more involved his knowledge and training are now.
That said, education does not always account for the quality of the professional. Those who are most defensive are in one of two camps. One: Really bad or Two: Really good. The really bad are obvious. The really good on the other hand have gone out of their way personally to expand their knowledge base and enhance their abilities and services. So some of the chiros here that are ticked at this type of thread, you may be set apart from the majority as a well trained and concientious life long learner, who personally would be ahead of most in your field...On the other hand you could also be a chiro who doesn't do any of those things and simply through ignorance assumes an all knowing and all capability position, which usually stems from ignorance, not brilliance. I think here we have both. Fortunately more of the Type Two practitioners...but the odd type One peaks in now and then...YOU know who you are!!
I respect that the depth to which I had to study anatomy etc. is not nearly as comprehensive as med school and I am okay with that. Despite that, I know more about rehab than most docs. I certainly don't know alot about other things.
A comment too about the hours of study list above...I noticed an incongruency between the amount of time spent learning diagosis and that spent studying pathology...how can you diagnose if you don't know the pathology you are diagnosing for? Just a thought.
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Re: Chiropractic vs PT as a profession- - January 15, 2004 5:15:00 AM
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DocZon
Posts: 70
Joined: April 19, 2003
From: Winchester, MA
Status: offline
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ColoradoJulie-
Thanks for your post. Well said without stepping on too many toes. Obviously, the ortho surgeon's depth of knowledge is greater. His depth of knowledge after 4 years of med school however is not greater than many chiros. I interned with an orthopedic group for 6 months and we had 3rd and 4th year med. students as well as residents coming in all the time. Trust me, a 4th year med. student does not know much about musculoskel medicine. You know about 1000x's more just from reading your posts.
I remember one day during rounds a basketball player came in with a scaphoid fracture with AVN. It was clear as day. PCP said it was a sprain. I stood in the back of the four 4th year med. students and one 1st year ortho resident. I was the only one who picked it up. The orthopedist told me to leave them in radiology suite and he would give me $10.00 if they could even find the scaphoid.
Listen to somne of these stats:
1 in 3 medical residents graduated without a single course in orthopedics.
Average time spent in orthopedics courses was 2.1 weeks. This represents 2% of the full medical school education. You are telling me that a recent graduate of a med. school has a better understanding of orthopedics than a chiro graduate or a PT graduate? Come on.
My job was to teach the residents and med students to differentiate a lumbar sprain from a disc and how to tell if someone had sciatica. How basic is that?
Med Grads Flunk Musculoskeletal Exam
--------------------------------------------------------------------------------
82% "Failed to Demonstrate Basic Competency"
A recent study in the Journal of Bone and Joint Surgery1 concluded what many doctors of chiropractic have long suspected: "Current medical school training in musculoskeletal medicine is inadequate."
About 23% of patient visits to the family physician and 20% of visits to emergency rooms are for musculoskeletal complaints.
To test the level of musculoskeletal competency among recent medical school graduates, researchers developed a 25-question test. The test was reviewed and validated by 124 orthopedic chairpersons from residency programs across the United States. Further validation was made by having eight chief residents in orthopedic surgery take the test. The eight surgeons passed the test with a mean score of 98.5%. Basic competency was judged to be a score of 73%.
Eighty-five first-year medical and surgical residents at the University of Pennsylvania School of Medicine were administered the test on their first day of residency: 61 were medical residents, 17 were surgical residents and seven were orthopedic residents. The 85 residents were graduates of 37 medical schools.
In their medical school training:
44 (52%) of the residents had taken the required course in orthopedic surgery (average duration 1.3 weeks);
20 (24%) had taken an elective course in orthopedic surgery (average duration of 5.6 weeks);
7 (8%) had taken both courses;
28 (33%) took neither course.
The average score of the 85 residents was 59.6% (73% was considered passing); the highest score was 86%; the lowest 35%. Only 19 residents earned a passing grade; 70 (82%) "failed to demonstrate basic competency."
The orthopaedic residents performed the best with an average score of 74.1% (only one percent over passing). The medical and surgical residents did about the same with average scores of 58.4% and 58.1% respectively. The failure rates broke down as follows:
Orthopedic Residents: 3 of 7 (43%) failed
Medical Residents: 53 of 61 (87%) failed
Surgical Residents: 14 of 17 (82%) failed
The authors concluded
"The current study clearly documents the inadequacy of medical school education with regard to musculoskeletal medicine. The duration of the residents' preparation in this area was inadequate. For the study population as a whole, the mean duration of instruction in orthopaedics was only 2.1 weeks. In addition, 28 residents (33%) had graduated from medical school with no rotation, required or elective, in orthopedic surgery; these residents had the lowest mean score (55.9%) on the examination and the highest rate of failure (93%).
"However, those who had taken a course in orthopedic surgery in medical school were not found to have a significantly higher mean score than those who had not, perhaps because the standard required course was too brief for the essential information to be conveyed."
While this discovery supports what DCs have suspected all along, it may be a key factor in why MDs don't cooperate with and refer well to doctors of chiropractic. Their lack of understanding also makes them a poor choice to act as gatekeepers for musculoskeletal problems in managed care environments.
One can't help but wonder how this shortcoming can be overcome. Perhaps it will be DCs that teach MDs what they didn't learn in medical school.
Reference
1. Freedman KB, Bernstein J. The adequacy of medical school education in musculoskeletal medicine. J Bone and Joint Surg, 80A:1421-1427. Oct. 1998.
Our anatomy class was taught by an MD who also teaches the anatomy courses at the University medical school. Same syllabus and same exams. he told us that on the first day. He would even tell us the average scores for the chiros vs. the MD's. We as a collective group, usually scored a few points below the MD's on average. We beat them a couple times though.
PT anatomy courses may not be the same as med school anatomy. But the chiropractic curriculum's anatomy program is the same.
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Re: Chiropractic vs PT as a profession- - January 15, 2004 5:24:00 AM
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DocZon
Posts: 70
Joined: April 19, 2003
From: Winchester, MA
Status: offline
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To: ColoradoJulie and anyone else
If you post your fax number, I will send you a copy of this musculoskeletal exam. It is not difficult, hard to believe so many medical students and residents flunked it. I can't seem to post it online though, so I will be happy to fax the article to anyone who wants it.
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Re: Chiropractic vs PT as a profession- - January 15, 2004 5:51:00 AM
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DocZon
Posts: 70
Joined: April 19, 2003
From: Winchester, MA
Status: offline
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ColoradoJulie-
Some of my post did not appear.
I understand what you are saying about your PT anatomy not being as in depth as medical school. I have heard this before. However, chiropractic school is as in depth. Our anatomy course was taught by a professor who also teaches/taught (not sure if he is still there) at the university medical school.
The first day of class he said, "I teach at the university, the syllabus is the same, the content is the same and exams are same. No special treatment."
He would even compare our test scores with those of his students at the university. Honestly, we scored a few percentage points lower on most of the exams. On a couple though, we did have a higher average score.
I think it gave us a little bit of an incentive to do well. Anyway, I am glad you are o.k. with your PT anatomy, but chiropractic college anatomy is the same as med school anatomy.
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Re: Chiropractic vs PT as a profession- - January 15, 2004 6:29:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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DocZon,
My anatomy courses (I had 4 semesters of it in my MSPT program) were taught by three PhD's one of exercise phys, one of anatomy, and one of neuroanatomy (and an MD/PhD). The primary human anatomy guy also taught at NYCC --- which I hear ya'll proclaim as one of the better non-straight schools --- and gave the same "Anatomy is anatomy" speech. The gross human course was taught by the MD/PhD who also taught Anatomy for the medical students at University of Rochester. He used a community PT and a med school resident as his teaching assistants. ALL stated that the anatomy course we received was "harder" than what the med students had. What criteria they used to arrive at this conclusion, and what they meant by "harder" I've no idea --- but that's what they said.
That doesn't make either DC's nor PT's physicians. The only difference between you and I is that one of us has no delusions that some equality of didactic coursework produces equal level clinicians. You're a chiropractor --- no more, no less.
What makes us different is the clinical education and daily drilling --- let's see, MD's have a 4 year residency, PT's have an 8 to 12 month clinical "residency" which is not nearly as rigorous. DC's don't have any clinical internship program that rivals even that of physical therapists. Unless something has changed in the less than 10 years since I walked out in disgust DC clinical education is all internal and inbred within the chiropractic "college" walls. It was one of my chief complaints, but to have exposed students to the rigors of clinical and scientific scrutiny before graduation could have contaminated the chiropractic brainwashing process --- and the chiropractic establishment just can't have that. By "that" I mean true scientific questioning . . .
Besides, your argument is COMPLETELY wacky and based upon little more than the illogical ego-stoking so pervasive among chiropractors. It’s like saying that just because both Emory and Life are in Atlanta, and there may be a professor or two who teach both radiology and anatomy at both programs, that DC’s from Life and MD’s from Emory are equals in terms of their abilities to function as primary care physicians. PLEASE tell us you don’t believe that load of garbage! It’s like saying that just because you took the same undergraduate physics course in school as NASA director O’Keefe, that you could have coordinated the landing of the NASA Spirit lander just as easily. Don’t be so nieve.
Be careful of throwing stones from that glass house you're living in.
Drew
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Re: Chiropractic vs PT as a profession- - January 15, 2004 7:12:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
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Anthony,
I said nothing about being an expert. I'm as much an expert on chiropractic education as any DC is on physical therapist education or medical education. Your point about having left chiropractic school (in what is widely regarded as one of the "upper tier non-straight school that sure as heck considered itself superior to Logan) after a few courses is well taken --- but few DC's have any physical therapist training and the ones that do generally went to bottom-tier PT schools or went to PT school so long ago (e.g. more than 10 years ago) so as to be out of touch with current physical therapist education and scope of practice --- and therefore have thought and ideas that contribute little to current thinking on the issue.
I admit I took chiropractic classes nearly a decade ago, but I submit that chiropractic education and vision of practice scope has changed far less than has that of physical therapy over the past 10 years.
I can only contribute from within my scope of experiences --- if you don't like what you're reading --- we'll I can't help or be responsible for that.
As Scanner likes to say, "I ain't so hot, you ain't so hot," but I do note that you've done nothing to challenge or correct any "errors" you may think I had in my previous post. Seeing none, we'll simply assume that you're once again not happy with the realization that you may have been professionally over-inflated in regards to the quality and rigor of the education that you recieved as a chiropractor and have nothing real nor significant to contribute to this debate other than internal anger and frustration.
I feel for you, but this isn't the place.
Drew
[This message has been edited by Andrew M. Ball PT PhD (edited January 15, 2004).]
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Re: Chiropractic vs PT as a profession- - January 15, 2004 9:09:00 AM
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DocZon
Posts: 70
Joined: April 19, 2003
From: Winchester, MA
Status: offline
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Dr. Ball-
I agree with you on many levels. There is a lot of over-inflation going on at the chiro schools. Perhaps, I may have been a victim of it at one time. I don't think I am now, although you probably would disagree. Your analogy of Life and Emory is completely off-base. this is not what I am saying at all.
I never said that equality of didactic coursework produces equal level clinicians. Equality of coursework is equality of coursework, no more or no less. I am just saying that there is "some" equality.
If Joe Smith, MD, PhD, Anatomy professor teaches gross anatomy at Harvard Med and also teaches the exact same course at City Community College in the middle of no where, it is the same course. The type of school doesn't make it any different. NYCC may have been different, but mine was not.
It sounds like you think we are saying that just because a DC takes the some of the "same" classes as an MD that we think we should be doing surgery. Of course you can't compare the two.
Chiropractic would go a long way if it were to embrace a residency type program similar to that of PT's. We don't have that constant drilling. I did experience it during one of my internships with a orthopedic surgeons group. I learned a lot that I never would have learned had chiropractic school been 20 years long.
And no, I do not think chiros are qualified to act as primary care physicians, nor do many even want to. I love the fact that when a person comes to me from their PCP or ortho, that all the "big" stuff has been ruled out. When the x-rays have been read by the radioogist, I know I won't miss something.
I think we will have to agree to just disagree on this issue. I too am becoming tired of this debate. Don't throw the towel in on the chiros. It sounds like you hate the entire profession.
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Re: Chiropractic vs PT as a profession- - January 15, 2004 9:56:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
Status: offline
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It’s been a while since I’ve been long-winded --- so here we go (Drew inhales deeply)
Anthony,
No pissing match intended. I enjoy our debates, but I think that your chiropractic ego is a little over-inflated at times and you're touchy about being brought back to the reality of chiropractic healthcare and its place within the hierarchy of American healthcare. It’s nothing personal, so please don’t take it as such. You’re certainly not an island among chiropractors. My intent is not to offend. In fact, (and at the risk of sounding condescending, which is not my intent) I respect both your willingness to now expose yourself to competing views and I think you’ve shown tremendous growth in that regard.
As for Suzie, I assume that Suzie is a DPT, a doctor of physical therapy. As we've discussed previously, it's a non-medical clinical doctorate just like a PsyD, PharmD, OD, DDS, AuD, DrPH, DC, OTD, etc., etc. Being married to a DPT and working on the last few DPT courses myself, I took her not to mean that DC's are or should be subordinate to the superior training of a DPT, nor that DPT education is somehow equal to that of a DP or MD, but rather that DPT's are sick and tired of being thought of by DC's as subordinates. Perhaps I read a bit into her response. If in fact she's flaunting a DPT with her nose in the air --- I wouldn’t tolerate that from my wife, my self, and certainly not from her. I'd love to know what the subject of her independent dissertation might have been and who the chair of her research defense council might have been. Knowing that you were following the thread, however, I figured I’d let you and Dr. Wagner take care of that. I would have stood aside and let it happen. I’ve learned that silence is as powerful a debate weapon as anything else. Haven’t you?
You know me quite well Anthony. I play no favorites DPT or DC --- but I am a busy guy and can't challenge everyone on every little thing. If you've a concern about a DPT's use of the term "doctor," then take it up with them. They aren't likely comparing themselves to an MD, but rather saying something along the lines of, "Hey Mr. DC, I could do without the attitude in this discussion. I've a clinical doctorate too and your lack of respect for my doctorate is more than a little insulting." Unless something has changed, Anthony, when you use the term "doctor" or "chiropractic physician" you mean to imply that you're an equally trained, natural alternative to a medical physician, physical therapist, or nutritionist. You're not --- and that's a different ball of wax entirely. DPT’s don’t mean that --- not ever.
AZDC,
I understand what you're trying to say, and agree with you more than you think, but I still think that the premise is a little off-base. Anatomy is anatomy after-all and is the building block of clinical coursework of many professions --- it's like the building that addition is to multiplication is a building block of calculus, etc. It’s not the basis for clinical education nor clinical judgments. I agree that DC’s get good building blocks for some basic science education, but generally no better than that of today’s DPT or MD program. I agree that we ALL have pretty good basic science foundational education, but that’s not the point of this discussion. My point is that as a group, chiropractors tend to over-generalize their didactic education into clinical application, and that’s not only dangerous, but it allows a level of professional ego-inflation over other professions that’s simply not justified by training. Training and education, are two different things, so let’s try not to get the terms confused.
If two people had addition class from the same professor at two different schools and one went on to become a CPA and the other works a register at the local mall --- well, I don't have to tell you who's going to do my taxes.
I am not saying that DC's think that just because a DC takes the some of the "same" classes as an MD that they think they should be doing surgery; but many DC's like Anthony here, think (or at least used to think) that makes them effective primary care physicians --- not portal of entry practitioners. I just don't agree with the logic considering the lack of rigor, or complete absence of, true clinical education. Just my opinion.
I couldn't agree more with your statement that, "Chiropractic would go a long way if it were to embrace a residency type program similar to that of PT's," but it goes beyond that. DC programs are isolated stand-alones. It's not just the students that need to be challenged and kept in check, it's the faculty too. That's why I'm so militantly for a state-funded chiropractic school within the FSU system.
In the end, sooner or later, DC's and DPT's will have to realize that their training, scope of practice, and place in healthcare is expanding in overlap. Sure, DC's aren't doing much in the way of wound care or skilled acute neuro-rehab, but I don't see many DPT's jumping into the perils of portal-of-entry care either. We CAN get along if we choose to. So far, we just don't.
Finally, I am not negative on chiro. I think that most DC's are far more skilled manipulators than most any PT regardless of training. I have spoken at length about the ethics of "relative expertise" guiding practice, and moving beyond scope of practice issues. It's a shame that because PT's have historically worked under MD referral, that PT's tend not to refer to DC's as necessary by the clinical case because they are afraid of irritating an MD referral stream. If the ACA and state chiropractic boards BACKED direct access to PT under Medicare, it is my opinion that it would HELP your profession in terms of DPT to DC cases, not hinder it by virtue of inviting competition. Let's face it, although the injury might be the same, the type of person that walks into a DC's office off the street versus someone who walks into a DPT's office --- are quite different. We COULD help each other by creating a situation where we could educate the patient on the merits of specific aspects of their clinical case for the cross NMS professional --- to date, we choose not to. In the end, I fear it to be the possible undoing of BOTH chiropractic and physiotherapeutics --- now wouldn't the MD's and ATC's just LOVE that????
WAKE UP YA'LL! The APTA and ACA should be best buds, not mortal enemies!
Drew
[This message has been edited by Andrew M. Ball PT PhD (edited January 15, 2004).]
[This message has been edited by Andrew M. Ball PT PhD (edited January 15, 2004).]
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Re: Chiropractic vs PT as a profession- - January 15, 2004 10:25:00 AM
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DocZon
Posts: 70
Joined: April 19, 2003
From: Winchester, MA
Status: offline
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Well said Drew. We can leave it at that.
On a separate note, be sure to watch
Survivor Allstars, my brother Ethan (same last name-Zohn) will be competing again. Will air right after the superbowl. He was the winner of Survivor Africa last year.
Best,
DocZon (Lee Zohn)
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Re: Chiropractic vs PT as a profession- - January 15, 2004 4:13:00 PM
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Dr.Wagner
Posts: 1237
Joined: January 24, 2003
From: Indianapolis
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I have been gone for a while...hasn't really gone anywhere.
That is very cool about your brother, my wife thought he was cute.
Come to [URL=http://www.chiroweb.com]www.chiroweb.com[/URL] for the weekly case study...I invite everyone. I post on that site because there seems to be the most interest there.
See ya.
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Re: Chiropractic vs PT as a profession- - January 16, 2004 7:13:00 AM
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Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
Status: offline
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Anthony,
Gee whiz I hope Suzie shows up sometime soon to comment!
You bring up a GREAT point that my profession is having trouble dealing with. Most DPT's are new graduates and it's considered poor form to push the doctor thing around BSPT's and MPT's. DPT's who were BSPT's and MSPT's (like myself) who go back to school are few and far between. Most are university faculty with PhD's or EdD's who were told to get a clinical degree or stop teaching clinical coursework (busted, it's at least one of my motivations --- who wants to teach nothing but Healthcare Management?!?!?!).
Cybercommunities allow for new grad entry-level DPT's to vent frustrations in that regard.
There is a VERY fine line between subtle confidence/pride, and perceived arrogance. DPT's are acutely aware of that. The one thing I understand, above all else, as the difference between our professions, is the culture. The DC culture is to push all education and certifications upon the public --- PT's tend to be far more reserved. My research would suggest it's partly a male/female thing, but there's more to it than that.
Personally, I object to the use of the term "doctor" in the clinic by anyone other than a primary care physician (that's not to say that I don't slip every now and then and introduce myself as Dr. Ball --- but it is ALWAYS followed by a comment about my being a PT with a doctorate in research and not being able to do anything other than physical therapy unless they happen to be a lab rat).
For any of us to refer to ourselves as "doctor" confuses the patient --- especially in a hosptial setting. A chiropractor is a chiropractor, a DPT is a physical therapist, an OD is an optometrist, etc. We can all pat each other on the back for being in the fraternity of non-medical clinical doctors some other time.
Just like DC's are touchy about being looked down upon by MD, DPT's are touchy about being looked at as anything other than thee expert in movement and NMS pathology by DC's. As a result of the percieved constant insult, DPT's generally don't give DC's the props they should for acute spinal care.
In the end, DPT's could learn a lot about the political mis-steps of chiropractic, but we appear destined to re-invent the wheel. (Sigh).
Drew
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