Chiropractic vs PT as a profession- (Full Version)

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5327echo -> Chiropractic vs PT as a profession- (September 28, 2003 10:46:00 AM)

Hi, I’m brand new to this forum and found it looking for answers in my search to decide which career is more poignant for me to pursue. Let me give a brief history on myself and then I welcome what I imagine will be quite a variety of responses...

My physical history has a bit to do with this so bear with me. I’m 34, in basically good health (could stand to lose 20 pounds, love beer and burgers a bit too much) however, am relatively athletic nevertheless (stretching cardio, weights 3 times weekly) BUT, I have a low back condition which came into play in my early 20's.

I first went to a family doctor who sent me to an orthopedic dr who took several x-rays and gave me a handful of pills and told me to lie down. Still hurt, bad, I could barely walk or use the bathroom. So I saw the doc again who referred me to another orthopedic dr at Baylor in Dallas. They took x-rays and said oh, we must cut you open and remove part of your disk material. That is the problem. It is bulged and pressing on your disks at L5-Si, and L4-L5. You have DDD and this condition will just worsen throughout your life. I said him, I will have to think about this.

Then a friend begged me to see a chiropractor. I agreed to try it and saw him 3 times a week for 2 weeks and my pain slowly went away. SO, I was happier and glad I didn’t require surgery right then..(I’m getting to the career part- be patient!)

To sort of summarize the years between then and now: I have been in varying degrees of pain or discomfort since then. I have been to every kind of Orthopedic Dr, Chiropractor and PT several times in 4 different states.

I was even evaluated by Dr Leslie Schofferman at the spine center at St Mary’s in SF, CA. The advice of their spine specialists [a group of neurosurgeons, orthopedics etc] was simply "Get off your motorcycle, and go see a chiropractor. We do not recommend surgery for you at this time". So as you might guess, this caused me to settle on chiropractic as a regular treatment and through it I have been able to live a pretty much normal life...for the most part.

Each group (ortho, neuro, chiro, pt) diagnosed my condition in exactly the way they were trained to and they all hold dearly to their personal philosophies on the best way to treat or handle it.

What does this have to do with my posting on this board?

I have decided to make a career change and am seriously considering Chiropractic as a new career. However, I see value not only in Chiropractic but also in PT and other non surgical treatment methods as well as the use of surgical methods when required. Please don't get me wrong, if my bone is broken I want to see the DOCTOR not the CHIROPRACTOR. But it seems they both have their place.

I understand very well the difference in approach between Chiropractic and more traditional medicine (although obviously I am not trained in either yet) and I also recognize the heated debate that exists between "alternative medicine" and our purely scientific doctors in the US medical community...but I am having trouble understanding the debate between the PTs and Chiros on this board.

My experience is that both have helped me personally and that they both have their validity and limits.

Ultimately I would like to have an "Integrative Medicine" facility which included experts in Chiropractic, PT, Ortho and Neuro surgery and even lower level health maintenance personnel such as massage therapists and diet consultants. The focus of this facility would be helping patients with musculo-skeletal disorders and chronic pain as well as sports oriented rehab. I have seen several facilities which are similar to this but not quite the same model.

I just don’t see how the model of medicine can remain the same. I don't see the point in debating whether the spiritualesque influences of the origin of chiropractic or the "break and fix" pill-and-a-knife mantra chanted by almost every orthopedic doctor (which I have noted most PT's seem to embrace) is of ultimate authority. I don’t understand why the ultimate goal cannot simply be the health of the patient.

What I am looking for here are some responses to these sentiments.

I have returned to college...at age 34 but I have 2 years before I will complete my Biology degree which gives me a little time to consider my next move. I have no desire at all to pursue an MD or surgically oriented career at all.

I have personally experienced the benefit of Chiropractic. However, I have also seen plenty of loonies, and have even been adjusted by a couple, not knowing any better how to spot a bad chiropractor in the past. I have been to PT, it also greatly helped me and has allowed me to even continue anaerobic activity (even some Chiros advise against this which I think is wrong)

What are the advantages and disadvantages of either or both (Chiropractic, PT) Would one lend itself to my vision of an “Integrated Health or Therapy Center” or [whatever you want to call it] over the other?

Any and all input is appreciated, I ask though that you please bear in mind that I am only an undergrad biology student currently and do not have advanced medical training of any type at this point so please use terms that are appropriate.

Thanks much

KH



DC_Student -> Re: Chiropractic vs PT as a profession- (September 28, 2003 9:45:00 PM)

I would strongly discourage you from going to Chiropractic school. The profession is entrenched in unethical business practices, limited usefulness, invalid techniques, poor education, etc. Go to PT school or become a MD/DO.

Best wishes,
Nemo



Scanner -> Re: Chiropractic vs PT as a profession- (September 29, 2003 5:53:00 AM)

I don't recommend anyone go into healthcare nowadays, PT or chiropractic, but here goes:

Advantages of PT school:

1. University/liberal art based curriculum
2. Choice of private practice, hospital based practice,
3. Assistance in the transition from school to career (rotations).
4. Get to spend time with patients and reimubursed for that time.
5. No stigma associated with that profession - enjoy regular medical referrals from the get-go.
6. Many more salaried positions to choose from compared to DC schol.

Disadvantages of PT school:

1. Somewhat capped on ability to make money.
2. No "doctor" status (yet you still command respect in community)
3. Limited scope of practice - no ability to order lab, x-ray, MRI.

Advantages of Chiropractic School

1. Doctor status (but still has stigma. . .)
2. Larger scope of practice than PT (but obviously smaller than DO or MD)
3. Sky is the limit is practice income.
4. Set your own hours - self-employed, etc.

Disadvantages of Chiropractic School

1. 50% failure rate in practice. *Editors Note* - I know many arguments have been forwarded that this isn't true but my friend who I keep in regular contact with went to the 5 year homecoming and lo' and behold 50% of my peers from my class were doing something else after 5 years.
2. No transition from graduation to career.
3. Sucess is dependent on business skills.
4. Self-employed is double-edged sword. For instance, no group health insurance if you have a family.
5. Don't get to spend as much time with patients as PT's do.


I am sure I am leaving stuff out. If you want to expand upon any positives or negatives, just ask.

[This message has been edited by Scanner (edited September 29, 2003).]



DPTpro -> Re: Chiropractic vs PT as a profession- (September 29, 2003 7:58:00 AM)

I think Scanner did a pretty good job laying out the pros and cons of each.
I was once in your shoes. I was originally going to go into chiropractic but switched to PT and am very glad I did.
The ability to go out after school and get a good job anywhere in the country making a reasonable wage is huge. Also having an education that is based in a university (rather than a private chiropractic college) is an important point. You could attend a public university and get your DPT for a small fraction of what you'd pay for your DC.
Also being trained in hospitals and in all settings alongside other healthcare professionals is of incredible value- you won't get this nearly as well in chiro school. And then there is that whole philosophy crap you'd have to deal with...

As for scanner's mention of "doctor status." True PTs are not seen as doctors. Though most people would also not consider DCs doctors. Be aware that most PT programs now are producing Doctors of Physical Therapy (DPT) and this is the future of the profession.

Also if you haven't already checked it out I'd suggest you spend some time on chirobase.org where you can find some honest information about chiropractic. Honest, unbiased information on the profession is hard to find and this site serves as a great resource for people seeking truth.

As more than a few people out there can tell you- be careful before going down the chiropractic road it has led to successful careers for some but some very unfulfilling ones for many, many more.

Hope that helps.



OAK -> Re: Chiropractic vs PT as a profession- (September 29, 2003 11:43:00 AM)

There is alot of overlap between Chiropractic and Physical Therapy treatment however theory is completely different.

Physical Therapy has a common goal of discharging patients from treatment whereas Chiropractic's goal is to keep you comming back.

Also, I would have to completely diagree that Chiropractors have a larger scope of practice. There are alot of areas that PT's work in that Chiropractors don't but there is nothing that Chiropractors do that Physio's don't.



touchiba -> Re: Chiropractic vs PT as a profession- (September 29, 2003 11:53:00 AM)

Ignoring Oaks obvious bias..

In addition to all that has been said:

If you are one of those people who dont want to work for anyone and dont mind carrying a certain amount of responsibility, then consider chiropractic. With that carries a great responsibility both personally and professionally. Personally, you'll need to handle your own business, health insurance, etc. Professionally, you'll need to diagnose and manage patients properly.

If you dont mind working for someone, and dont want to be burdened with the responsibilty of making a diagnosis, then consider PT. Most patients that see a PT will be seen by an MD first, therefore having more serious illnesses ruled out. I'm not saying that a PT cant pick up on some things, but no one is going to go after a PT for missing a cancer or some other type of diagnosis.



touchiba -> Re: Chiropractic vs PT as a profession- (September 29, 2003 11:56:00 AM)

As for chirobase,

It is a great resource for information about the quackery that is found in the chiro profession. Just realize that much of what is listed is not practiced by the majority of chiropractors. Also, the site mostly attacks traditional, straight chiropractic.

Some of the articles are also a little out of date and incorrect.



Scanner -> Re: Chiropractic vs PT as a profession- (September 29, 2003 12:21:00 PM)

I don't want this to turn into an DPT vs. DC argument because yes, from what I hear, the DPT is a large scope of practice, if not a tad larger with ionophotoresis (sp?).

If I go to the PT next door in my little professional health park here (who I beleive has a masters), he will say this is how his day went:

1. Did a few new patient evaluations which consisted of measuring range of motion, orthopedic tests, neurological exam.
2. Assisted and educated patients on therapeutic exercise.
3. Applied modalities including some ionophotoresis
4. Wrote some reports back to the referring MD's (and occasional DC)
5. Did some stroke rehab. (something I don't do)

My day consisted so far of

1. Re-examining a patient for a slip and fall off a horse. Ordered x-rays and double checked radiologist for apparent fracture.
2. Saw a new patient with chronic headaches. Ordered lab and x-ray on her.
3. Did my usual chiro. care which consists of spinal adjustments and passive modalities.
4. Called and fought with insurance companies a little (a PT will be more insulated from this).

I just don't see any PT ordering lab work, MRI's, bone scans, x-rays. I know, I have heard here:

"By Golly, in Timbuck 2, Denmark, and Racoon Ear, Mississipi we can!" but 53ECHO, don't beleive it.

More than likely, day will not consist of ordering x-rays and lab work as a PT. The scope of practice is larger for a DC. Big deal - that isn't to brag or anything. I did present a lot of what is wrong with going into chiropractic. Take it for what it is worth.



nrl -> Re: Chiropractic vs PT as a profession- (September 29, 2003 1:08:00 PM)

to pick up on the this is how my day went theme. I work with ortho patients.
1. a few new patient evaluations – interview (functional demands ,pain behaviors, expectations etc.) functional tests, ROM, orthopedic tests, neurological exam.
2. tried to be effective in education – habits, physical activity, pain.
3. some manual therapy – soft tissue, manipulation.
4. therapeutic exercise – trying to apply motor learning principles, function, sport and more. Real fun stuff. You can let your imagination run.
5. modalities – but hardly ever u.s. (not effective).

Probably forgot a few things. Oh, yes, when working with an elderly patient on a verbal dual task during balance exercise, she told me her recipe to the best apple strudel.

I can not order x-rays or other tests which is inconvenient. But if I think one is needed I pick up the phone to the ortho MD or go next door to the GP (depends in which of the 2 places I work in) and ask them to write a referral.they usually do as i ask. Quite a few times I diagnosed , based on clinical exam ,a serious problem others missed. So if you earn the respect of the MDs you work with it’s not a big problem just an inconvenience.

Nirit



Andrew M. Ball PT PhD -> Re: Chiropractic vs PT as a profession- (September 29, 2003 1:23:00 PM)

I'm amazed by the lack of understanding between our two professions. As many of you know, I spent time in DC school after completion of my MSPT and before walking out to do an MBA/PhD.

Here's my take:

DC's DO NOT have a grander scope of practice than PT. PT's DO NOT have a grander scope of practice than DC. There is the DC's illusion that DC's scope of practice is larger because they can order lab work and x-rays, but the PT have the same illusion because they work with neurodevelopmental pediatrics, cardiopulm patients, post-stroke, and a whole host of patient populations that DC's simply aren't trained to work with.

Does a DC have a larger scope than an ORTHO PT??? Yes! Does a DC have a larger scope than the profession of PT??? NO!

Our scopes are simply different, with considerable overlap. What's all the hub-bub?

Drew



Scanner -> Re: Chiropractic vs PT as a profession- (September 29, 2003 1:55:00 PM)

Drew,

Let's not confuse exposure to pathology to breadth of scope of practice. One is a training and a career issue; the other is a legal issue.

So, okay, let's say this:

Advantages of PT School

1. You will see a wider variety of pathology in school.

Advantages of DC School

1. You will have a wider scope of practice powers such as a diagnostic testing ordering and performing x-rays.



coloradojulie -> Re: Chiropractic vs PT as a profession- (September 29, 2003 7:28:00 PM)

A typical practice in Colorado:

I own my own PT practice, well practices actually we have a satellite office. I don't work for anyone but myself and I employ 5 people. I have grown the practice over the last 8 years and have had as much autonomy has anyone would want. I have gained the respect of many physicans in the area and many refer to me directly on a regular basis, modestly, telling patients I am the best in the area. They know I don't just rub on people or show them how to stretch their hamstrings. So things I did this week:

1. Shadowed an orthopedic surgeon for half day, assisting in evaluation (especially when xrays, mris fail to show any structural pathology)patient education.
2. Meet with new physicians and educate them about the role of PT and appropriate referrals.
3. Market the clinic. Whole different area for me which I find challenging and interesting.
4. Communicate with my state and national reps about concerns and issues.
5. Treat a diverse out patient population creatively and effectively. We have all the bells and whistles, but when it comes down to it that is all they are.
6. Meet with local orthopedic surgeons for formation of referral patterns and median rehab structures post op.
7. Attend sports medicine conference in Aspen and meet some top docs, learn about the latest surgical procedures and research.
8. Get on line at rehab edge and debate. [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
9. Go to the Steadman Hawkins clinic and listen to their spinal specialist discuss the pathomechanics of cervical and lumbar discs.
10. Attend to billing and collection issues.
11. Hold a staff meeting.
12. Create policies and procedures for the clinic.
etc. etc. etc.

Surprisingly I am very fulfilled despite not being able to order an xray...

No matter what field you go in, you will be the practitioner that you want to be. If you are lazy you will practice the basics, work for someone, never learn anything new, and just do your time. If you want to be the best at what you do you will be innovative, constantly upgrading and pursuing your skills, and maybe even going into business for yourself.

My personal PT experiences have been in ICU respiratory, acute inpatients, stroke rehab, burn rehab, pediatric respiratory, spinal rehabilitation in new zealand, long-term care, inpatient orthopedics, and the one I have settled on is outpatient ortho. So lots of choices, and that is just the tip of the ice berg.



OAK -> Re: Chiropractic vs PT as a profession- (September 30, 2003 7:16:00 AM)

Great post coloradojulie! You mentioned that you do alot of marketing of your clinic. I have just opened my own clinic in Canada and I was wondering what type of marketing you found to be the most effective?



mcap56 -> Re: Chiropractic vs PT as a profession- (September 30, 2003 8:30:00 AM)

I thought scanner did a good job of outlining the differences.

mcap



OAK -> Re: Chiropractic vs PT as a profession- (September 30, 2003 9:31:00 AM)

I'm still having a huge problem the statement that Chiropractors have a larger scope of practice than Physical Therapists.

Physical Therapists are educated and trained is several areas of practice that Chiropractors are not involved with. For example stroke rehabilitation, cardiorespiratory rehabilitation, post op orthopedic rehabilitation etc...

Other than order x-rays what do Chiropractors do that Physical Therapists don't?



flexion -> Re: Chiropractic vs PT as a profession- (September 30, 2003 10:10:00 AM)

I think scanner did the best job answering the question posed as well. The typical day scenerio's though were very interesting and I think we all might learn from each other to describe our typical day.

As a DC here is my typical day - paperwork seems to be the thing that strikes me the most. Proposal documents, research initiatives, lecture opportunities fill the gaps.

Saw 17 patients in 7 hours.
1) continued MVA WADII rehab - showing typical recovery
2) complete assessment for fall injury with ankle sprain, costochondritis, teres minor sprain and contusions - formulated plan for Tx - fire letter to MD
3) continued Tx of arm non-displaced Fx for WCB case - order re-eval x-ray to assess healing.
4) review EMG report subsequent to MRI for lumbar disc with patient refer out for PT as no significant progress - consult with MD regarding poor progress.
5) re-eval for patient with orthotics RE: plantar fasciitis - doing well re-eval 6 months
6) continued MVA rehab for biceps and supraspinatus sprain - complete Tx plan and disability certificate for insurance company
7) complete assessment for severe HAs. Dx myogenic HAs referred for massage therapy. No Tx. Fire letter to massage therapist and MD.
8) continued MVA rehab for WADII and LB sprain/strain - patient still in severe pain - contact MDs nurse on patients behalf to request refill T3s. Fire out progress report to insurance company.
9) continued Tx on acute cervical disc - review x-ray findings with patient - MRI on order
10) continued Tx for WCB case lumbar spine radiculopathy. Patient getting cortisone injection - explained pros/cons. Fire letter to WCB regarding upcoming injection by MD.
11) continued care for B carpal tunnel - call up brace place with sizing and order braces for patient.
12) discharge appointment for MVA - reaffirm self directed focus and release from care. Fire discharge report to insurance company.
13) consultation regarding posture and exercise program - fire letter to MD.
14) continued care for chronic thoracic spine tightness - reaffirm exercise program
15) Tx MD with chronic rib problem - suggest stop popping vioxx so much... LOL
16) continued Tx on compartment syndrome patient
17) casting for orthotics for patient with recurrent metatarsalgia.

Billings were 894.00 and receivables were 1809.00 on this particular day.

Is PT better or DC better?? - each profession is what you make of it as ColoradoJulie has noted. I think its important to in whichever field you choose:
1) be honest and don't milk the system
2) respect your patients and other healthcare providers
3) work on your business and not in your business



Scanner -> Re: Chiropractic vs PT as a profession- (September 30, 2003 10:49:00 AM)

[QUOTE]I'm still having a huge problem the statement that Chiropractors have a larger scope of practice than Physical Therapists.
Physical Therapists are educated and trained is several areas of practice that Chiropractors are not involved with. For example stroke rehabilitation, cardiorespiratory rehabilitation, post op orthopedic rehabilitation etc... [/QUOTE]

Oak,

I am not trying to be a smart alec but herein lies your answer:

What can you do as a form of intervention for those patients?

In fact, what is to stop all chiropractors from going after those jobs if we wanted. Let's say we developed post-graduate diplomates/residencies in all of those fields and wanted to take over that market and the heads of our college departments made a huge marketing push to get their grads in these programs (unlikely but this is argument). What would stop us?

Nothing is to stop us, other than years of political bias and prejudice, right?

[QUOTE]

Other than order x-rays what do Chiropractors do that Physical Therapists don't? [/QUOTE]

Obviously, perform manipulation.

In my state, I can order bone scan, MRI, PET scan, tomogram, lab tests, dopplers, etc. although yes, 98.5% of my testing is probably x-ray.

Here is an example of how we may approach a case differently:

A patient comes in with LBP and we are doing are things that we do - you are educating and reconditioning the back and I am doing spinal manipulation and educating on home exercise.

Around the 6th visit the patient reports leg pain in the calf, isn't quite sure about numbness. The patient is a 48 year old female who smoke and takes estrogen replacement from hysterectomy 15 years ago. Reflexes are normal as are myotomes and dermatomes.

Being the astute diagnosticians we both are, we both suspect possible DVT and also place a HNP is the differential diagnosis. I order a stat doppler US (although I know it is debatable nowadays that that is the litmus test for DVT) to r/out the pathology and have records faxed over to her PCP (I should probably do a Chem panel, CBC, and PT/PTT too but I'll leave that to the PCP), while arranging for an immediate apt. with her PCP.

You call the PCP, who does the same things along with perhaps immediate pharmaceutical intervention.

Another example:

A 54 year old female enters my practice with history of smoking and steroid drug use. Doesn't visit OB/GYN regularly (fear of internal exams) or family doctor.

I get a baseline DEXA scan to r/out osteoporosis before beginning chiropractic care along with x-rays to assess degenerative disc disease I suspect is present.

I educate importance of yearly PAP smears and self-breast exams and make referral to OB/GYN.

Results come back - osteopenia/borderline ostoporosis. Diet education, smoking cessation, and a consulation with a PCP is in order

Do you see the pattern I am trying to portray here? I am not trying to play one upmanship with you because you have a lot going for your profession that we don't. And as Drew said, there is a lot of overlap.

Yes, if I were ECHO, I would not make a choice of chiropractic just because of the slightly bigger scope of practice we have.

Is that better?


[This message has been edited by Scanner (edited September 30, 2003).]



OAK -> Re: Chiropractic vs PT as a profession- (September 30, 2003 12:53:00 PM)

Dear Scanner,

Scope of practice includes the tasks that a professional is trained to do and performs under a normal situation.

Just because you feel you could perform a specific task if you wanted to does not mean that it is part of your scope of practice. (ie. I think P.T.s are capable of handing out NSAIDs but that does not mean prescribing medications is in our scope of practice.)

Furthmore, many P.T.'s regularly perform spinal manipulation, as I do myself, so I don't see how you answered my question about what sets Chiropractors apart from P.T.s.



Scanner -> Re: Chiropractic vs PT as a profession- (September 30, 2003 1:37:00 PM)

Dear OAK,

Obviously, we have different opinions on what "scope of practice" means. To me, I am describing "scope of practice" and you are outlining a "daily job description" or different career opportunities, which I agree there are more for PT's.

I will just agree to disagree with you.

Your friend,

Scanner



Diane -> Re: Chiropractic vs PT as a profession- (September 30, 2003 1:56:00 PM)

Hi OAK,
I think Scanner is referring to a stricter definition of "scope of practice" which is specifically about what a profession is entitled by law to do legally and with exclusivity and impugnity. Legislation is the only "final" way to determine who is entitled to do what, and to whom, and when...etc.

Take ultra sound for example. Here in BC, the College jumps hard on any PT who teaches an aid to do ultra sound to save time. No one, and I mean NO ONE!!!!! is permitted to touch the ****ing ultra sound to a patient's body except a lisenced PT.. any PT who tries to get around that ends up in deep doo-doo with the college. So while it can be a pain, from inside the rules, to have a scope of practice that doesn't allow anyone but a liscenced PT to do somehing as mind-numbingly boring as ultrasound means that ALL others, including MDs or DCs or XYZs, CAN'T use it EITHer and our college could legitimately go after any one who tried. Thus is our "scope of practice" protected inside and out, by strong clear legislation and a strong college that enforces the boundaries.

Boundaries are contestable, and if you have a strong lobby, a college that can persuade legislators to see the light and change the law to include into your profession's "scope of practice" a treatment tool that properly belongs there, like manipulation is for Canadian PTs, then the chiro profession can't treat PTs the way they are treating our Arkansas colleague.

Cheers,
Diane (far from a passive, egg-shell walker [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG])



[This message has been edited by Diane (edited September 30, 2003).]



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