|
|
Re: compromise of direct access campaign
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
Re: compromise of direct access campaign - July 8, 2004 2:45:00 PM
|
|
|
Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
Status: offline
|
The way proposed directly above is the way that I personally practice. The ability for DPT's to order any appropriate diagnostic tests and studies necessary for portal-of-entry care, to be able to independently diagnose and treat any and all neuromusculoskeletal conditions, and to refer to appropriate medical persons when the patient's needs are outside of the practice scope of the DPT; are all part of the APTA's vision for physical therapy practice by 2020.
Please don't confuse the two.
Personally, I DO NOT believe that PT's should be able to prescribe medications (but there are some who do, and in the military, PT's are doing just that), but I do believe that the ability to see patients in a direct-access AND direct-reimbursement fashion, to order appropriate diagnostic tests, to diagnose within our scope of practice --- SHOULD be commonplace DPT practice within the next 10 to 15 years. Patients should not have to see their MD for every ache and pain, just like an OD can diagnose and refer on when appropriate, the DPT should be able to do the same. If a chiropractor can do it, a physical therapist should be able to also. Currently, there is a paucity of PT's who are capable of assuming that kind of direct access role in a safe manner --- but that is changing.
As for medications, I personally think that vision shouldn't be part of the DPT vision. For most people, it isn't --- but that said, any DPT should be able to catch/suspect when an adverse drug effect is occuring and refer along.
You both are slightly missing my goal in all this. My desire to get a DPT isn't in an effort to inflate an ego. What neither of you understand is that there are many BSPT's and MPT's who think they've the right to direct-access and imaging WITHOUT de-facto and without additional training. My quest for a DPT is an INTERNAL professional statement, not an external one. I believe that simlpy opening the floodgates would be dangerous for patient care and after one or two lawsuits, destroy the profession.
My message to my colleagues is this --- "If you want direct access, if you want the right to order images, then the requisite education is a must!" That's where the discussion BEGINS, not ends. My colleagues simply don't know what they don't know if they're demanding these things and have never taken an imaging, pharmacology, or differential diagnosis course.
My message about the DPT is to my colleagues, not to MD's or DC's. "Put up or drop the issue, but don't pine for the goal and personally do nothing to attain it."
Drew
_____________________________
Dr. Andrew M. Ball, PT, DPT, Ph.D.
|
|
|
|
|
Re: compromise of direct access campaign - July 8, 2004 6:47:00 PM
|
|
|
Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
Status: offline
|
I think this issue will not be resolved, as I clearly see both sides of the issue...and I once believed as you do, but I felt rather than the DPT (as I was in a t-DPT prior to med school...it was grossly inadequate to prepare me in ANY WAY SIMILAR to medical school) I would pursue the gold standard...medical education.
It takes more than classes to be able to interpret the radiology you order...it takes more than a class to know what tests are needed and it takes lots of experience to know what is financially responsible and necessary.
I think the situation again comes up...do you REALLY want to be a PT? Don't you REALLY want to become a physician? You sound so friggin frustrated, frustrated by the limitations that you accepted upon entering the field...frustrated that no one will allow you to do the things physicians do, without going to medical school. You are frustrated at me because I know not only the situation you are in, but that I have been there before.
Drew, you need to really sit down and decide do you want to be a therapist that dabbles in medicine, or do you want to be a physician who has the ability to practice therapy and do EVERYTHING that the patient needs (the gold standard way.)
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
|
|
|
|
|
Re: compromise of direct access campaign - July 8, 2004 11:27:00 PM
|
|
|
Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
|
Hi. I am a military PT and am credentialled to order medication (mosty NSAIDs and muscle relaxants), radiographs, MRIs, Bone Scans, CT Scans, and Lab studies. These credentials are crucial for me when I am seeing direct access patients along side the primary care providers (PCPs). I don't think it is unreasonable or necessarily bad that PTs can learn when to order limited medication, order x-rays and the such.
We have recently started a direct access clinic where essentially I am working along side our primary car providers except that I see all the musculoskeletal injuries that come in. And it should be this way, the doctors agree, PTs are much better trained to evaluate musculoskeletal injuries. Having the credentials above is very helpful in my evaluations and interventions. This is a win-win situation all around. The PCPs (physicians, PAs, Nurse Practioners) love it because I am taking a lot of the workload from them allowing them to spend more time with other pathology (they would refer 85% of the musculoskeletal stuff to us anyway-this just cuts one more step out of the whole process). I like it because I am seeing the acute injuries even sooner than before. There is overwhelming evidence to support the effectiveness of PT intervention on acute injuries. The patients love it because they have quicker access times to physical therapy. How nice it would be for civilian PTs to practice like this. I have not even touched on the cost savings that would occur if PTs could practice like this.
Army
_____________________________
Alex Brenner, PT, MPT, OCS
|
|
|
|
|
Re: compromise of direct access campaign - July 9, 2004 3:19:00 AM
|
|
|
CarolinaPT
Posts: 20
Joined: May 6, 2004
From: North Carolina
Status: offline
|
Dr. Wagner, you talk about medical school like it is the apex of all schooling. I will never contest that it is intense, but the "schooling" portion is only 2 years. If the curriculum continues to be upgraded, it is a gap that can be spanned. I think to some degree that you are a medical school/DO school snob, and maybe PT school was as poor as you say it was 20 years ago when you went through. The biggest difference between the PT schools and MD schools is the fact that they have 2 years of shadowing and then a further 4 years of residency. If you want to argue that in order to gain some of these things that MDs/DOs have that PTs should also participate in more comprehensive and similar programs, I would agree. But to simply and categorically state that PTs should never be able to do these things because we would be dangerous and unable to learn the concepts is in my opinion a misstatement.
|
|
|
|
|
Re: compromise of direct access campaign - July 9, 2004 5:22:00 AM
|
|
|
chiroortho
Posts: 655
Joined: February 18, 2004
Status: offline
|
ArmyPT, I have nearly total respect for your input here, but I am very troubled as an individual that the military would simply hand you prescription rights. This violates all but military law. And I have to ask, how much training in utilizing pharmaceuticals did you get before you started writing prescriptions?
As you know, my profession is going through this stuff now, and it is a white hot issue. Training vs. liability vs. why???
I was born on a Navy base, and as a kid I remember my folks taking me off base for medical care, the implication being that the care on the base was suboptimal. And isn't it true that military doctors typically and very generally simply want to pass off patients every chance they get?
I guess my point is that if the base neurosurgeon could let the nurse do his brain surgeries, I wouldn't be surprised if he would.
_____________________________
Greg Priest, DC, DABCO
|
|
|
|
|
Re: compromise of direct access campaign - July 9, 2004 5:30:00 AM
|
|
|
Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
Status: offline
|
Army, the reality is that in the US (as I worked on a MAJOR AFB as a civilian contractor) PT's don't utilize care as you described, furthermore, medical malpractice is completely different in the private sector and changes the entire environment. Comparing military care in another country to that in the mainland US is unrealistic.
Carolina,
Well, in medicine or healthcare, the degree in medicine IS the apex. Classroom time is a tidal wave of info for 2 years, then during the clinical years there is testing once monthly with once-twice weekly classroom time. 3 steps of written licensure exams then residency.
The point has been over and over and over... (and I believe you are rejecting my idea simply because I am no longer a practicing PT) is that the venue for practicing is ALREADY in place, the gold standard=medicine. Every year PT's enter medical school and will agree with everything that I say.
Drew CLEARLY is frustrated with his decision, why would he struggle and try to CHANGE what he agreed to? I was frustrated so I went to school...he is frustrated and he will lobby to change laws.
I ask you, what do you say to a LMT or ATC who wishes to learn PNF or geriatric rehab or manipulation or wishes to start treating in ECF's or start using modalities....you tell them to go to PT school. And if they use the same argument that Drew uses...what is your response?
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
|
|
|
|
|
Re: compromise of direct access campaign - July 9, 2004 6:00:00 AM
|
|
|
Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
|
Dr. Wagner,
Airforce PTs do not have the same credentials as Army PTs and do not practice like I described. In many Army clinics PTs are working as I described above. I am not saying we are better clinicians, we just have more autonomy.
Greg,
I understand where you come from, however, I have a different view. I was also raised in a military family and have always had my medical care at a military hospital. I can only speak for the Army but I would say that my care has always been very good. I think military medicine is a good thing and have had many patients tell me they would prefer being seen in the military. But certainly there are many pros and cons to each. It probably depends on your personal experiences with the hospital. I would have to disagree with the physicians pawning off patients. I don't think that happens in the hospitals where I have worked.
As for prescribing medicine, I am credentialled to prescribe NSAIDs and muscle relaxers, and can order refills for some others. I would have to look at my recent formulary for the exact medications. I also recently learned to give cortisone injections but I have to get the medication from our PA. I had some basic classes in pharm while in PT school.
Army
_____________________________
Alex Brenner, PT, MPT, OCS
|
|
|
|
|
Re: compromise of direct access campaign - July 9, 2004 6:13:00 AM
|
|
|
chiroortho
Posts: 655
Joined: February 18, 2004
Status: offline
|
All I can say is that this is one heckuva scope expansion for you, Army.
But I have no doubt that you're doing a great job.
Greg
_____________________________
Greg Priest, DC, DABCO
|
|
|
|
|
Re: compromise of direct access campaign - July 9, 2004 11:37:00 AM
|
|
|
tr6454
Posts: 60
Joined: March 6, 2004
Status: offline
|
Greg,
Actually not really an expansion. Army PT's became primary care providers as 'physician extenders' after a demonstration study proved the PT's effectiveness in 1975. I had the same credentials as Army PT, 20 years ago. What makes it work is the colleagial work between PT's and MD's. Everyone is overworked so there are no turf wars. The discussion is focused on delivering the most efficient and highest quality care, given the available resources.
_____________________________
Terry
|
|
|
|
|
Re: compromise of direct access campaign - July 9, 2004 12:19:00 PM
|
|
|
CarolinaPT
Posts: 20
Joined: May 6, 2004
From: North Carolina
Status: offline
|
[QUOTE]I ask you, what do you say to a LMT or ATC who wishes to learn PNF or geriatric rehab or manipulation or wishes to start treating in ECF's or start using modalities....you tell them to go to PT school. And if they use the same argument that Drew uses...what is your response?[/QUOTE]Dr. Wagner, I don't think this is an accurate analogy to Drew's presentation. More accurate, would be not one ATC, but NATA, deciding that they wanted to add mobilizations to their scope of practice to more comprehensively treat their patients. I would say to this, if they add the appropriate education, good for them. I am not sure that everyone will agree with me, but in this instance it is a tool that will help them to accomplish their ultimate goal of patient care. And in the land of ATCs and their established patient, mobilizations may help. Without the appropriate education or training though, I would certainly be against ATCs performing this skill.
|
|
|
|
|
Re: compromise of direct access campaign - July 9, 2004 7:26:00 PM
|
|
|
Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
Status: offline
|
So in other words you would say..."go to PT school"
That is what I thought.
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
|
|
|
|
|
Re: compromise of direct access campaign - July 9, 2004 8:33:00 PM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
FLAorthoPT -
You made a good point in your post; you knew something was wrong, sensed maybe a red flag and referred on.
All PTs should be able to recognise red flags or at least be suspicious of certain s&s. Standard stuff. To deal with those issues is another thing, but already in the UK and to some extent in Australia, imaging can be requested and certain meds as well.These PTs are called Extended Scope practitioners, and do not have any extra special letters after their name. One of the aims for PTs here is to be first contact in the ED (patients are triaged, naturally), and the PTs refer onto doctors when it is clearly out of their field; this would save enormous amount of time for the doctors,and mean more efficiency in the area. Acute spinal pain is one area for PT input, so are the various non-threatening conditions.
There are lots of goals to work towards to expand the role of the PT without colliding with other disciplines. In various countries, I am aware the playing field is different; I believe some US PTs do wound care - we don't touch that, nor do we want to. Some physios here advise on NSAIDS, some do not want to. I am very happy for my 79 yo lady to chat with the pharmacist about her concerns with drugs; especially if her GP is not available for five days as is often the case. There are so many things we can do and do well,there is barely room to be specialised further.
Nari
|
|
|
|
|
Re: compromise of direct access campaign - July 10, 2004 5:50:00 AM
|
|
|
Jon Newman
Posts: 1707
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
Dr. Wagner,
Could you clarify your position on direct access for PT’s? I currently interpret your position as believing that direct access physical therapy would be tantamount to the practice of medicine. Is that correct?
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: compromise of direct access campaign - July 10, 2004 7:48:00 AM
|
|
|
Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
Status: offline
|
Since direct access for PT's is based upon state to state laws, I would need to see the written word to comment.
My current thoughts are aimed at 1. creating mandatory continuing education for all PT's on a yearly basis from certified providers prior to direct access. 2. To create mandatory relicensing examination for PTs on a 5-10 year basis 3. requiring a mandatory 1 year proabationary period for any PT prior direct access (from point of graduation). 4. To create mandatory certification in various specialties MANDATORY prior to direct access.
If these relatively small regulations were made by the APTA it would convince me that direct access is more than a self serving political goal for the APTA, but rather a self regulating educational goal. This type of self regulation and certification is FAR more legitimate and important than the DPT. To me, direct access needs to be directly linked to these requirements.
But...unfortunately, direct access is a political goal by the APTA and state to state laws reflect this. THere is FAR to much variation between states to agree to a blanket statement.
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
|
|
|
|
|
Re: compromise of direct access campaign - July 10, 2004 8:58:00 AM
|
|
|
Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
|
I retrieved this from a Nurse Practioner web site:
A nurse practitioner (NP) is a nurse with a graduate degree in advanced practice nursing. This allows him or her to provide a broad range of health care services, including:
1. Taking the patient's history, performing a physical exam, and ordering appropriate laboratory tests and procedures
2.Diagnosing, treating, and managing acute and chronic diseases
3.Providing prescriptions and coordinating referrals
4.Promoting healthy activities in collaboration with the patient
Some nurse practitioners work in clinics without physician supervision, and others work together with physicians as a joint health care team. Their scope of practice and authority depends on state laws. For example, some states allow nurse practitioners to write prescriptions, while other states do not.
Sounds like direct access to me.
Do NPs have as many regulations that Dr. Wagner suggests should be placed on PTs? Maybe I am wrong, but I don't think so.
NPs have already set a precedence. Why is it so hard for PTs to obtain this?
_____________________________
Alex Brenner, PT, MPT, OCS
|
|
|
|
|
Re: compromise of direct access campaign - July 10, 2004 9:33:00 AM
|
|
|
Jon Newman
Posts: 1707
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
Dr. Wagner,
Thank you for your honest answer. I think there is some food for thought in your response.
I am unfamiliar with the mandatory education or mandatory relicensing examination of MD's. Are there any?
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: compromise of direct access campaign - July 10, 2004 7:37:00 PM
|
|
|
Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
Status: offline
|
Army...NP's regulations are state to state... and was made law purely by LOBBYING. THEY ARE NOT REGULATED by state medical boards (scary) and I am not impressed AT ALL by their skills.
My feeling regarding the comparison...TWO WRONGS DO NOT MAKE A RIGHT. I have never seen a clinic (at least locally) where a NP works independently, and in the ED I sign off on all of their charts and see the patients immediately after they are seen by the NP. I guess I really dont see a logical argument AGAINST my previously stated points other than "they do it so why can't we".
Mr. Newman,
Yes there are continuing education and licensure laws for MDs and DO's...hell yeah!
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
|
|
|
|
|
Re: compromise of direct access campaign - July 11, 2004 4:11:00 AM
|
|
|
Jon Newman
Posts: 1707
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
Dr. Wagner,
Could you elaborate on the nature of those laws. Do they vary from state to state? How often do MD's/DO'S have to take relicensing examinations?
I really don't know.
Thanks!
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: compromise of direct access campaign - July 11, 2004 5:47:00 AM
|
|
|
mcap56
Posts: 619
Joined: October 26, 2002
From: New York, NY
Status: offline
|
This has become a somewhat contentious thread. I prefer the contentious ones but I am not sure that this one needs to be. It seems like most of us agree on the basics.......
1. The major issue - We all seem to agree that PTs should have direct access. If you can see a DC, accupuncturist, a massage therapist or other professionals without referral, why not PT?
2. I don't know any PTs that are trying to replace physicians. Yet, in years of practice, I have had no shortage of patients who treat their DC like a PCP. DCs advice people on medical conditions all the time. There is even a subgroup that advices against vaccination.
3. The DPT may be controversial, but it does not have to be. For all of the debate about the DPT, we seem to be ignoring the obvious. There are many, many DPT graduates out there practicing today. I don't see any of them walking around the hospitals calling themsevles doctor. Among 4 graduating classes at a local school, I don't know anyone that calls themselves doctor, in any situation.
4. When a PT does set up independant out-patient practice, the title, regardless of what you think, could help to level the field against DCs. PTs were already going to school for three years. Does th DPT ensure compentency in all of these new areas, probably not. But that really isn't the issue.
5. The main job of the PT with respect to differential diagnosis is to recognize when conditions are within the scope of practice or when referral is required. This will not change regardless of direct access or the DPT. Additional training in diff dx, pathology, imaging etc, could only improve this.
6. Debates about medications and test orders are just that. Debates. Whether you agree or disagree, it is certainly worth discussing. I personally don't care about and may not even want these priveleges. But it is worth a discussion. Dentists can prescribe just about any medication. NPs, PAs, ODs all have some limited priveleges.
7. This discussion can't be approached from the perspective that medical care today is so effective and that we are threatening quality of care. How many people die each year from preventable medical errors? How many times do we catch things that slip through? Are doctors doing so well with medication? How many people die each year from prescription drug abuse? How many people get the recommended care for common conditions? What about the new trend where physicians are putting MRI scanners in their own practices instead of referring out to radiologists (revenue generator)? What do expert reviews say about the quality of care in the US?
In other words, if public safety is the primary concern, then there are far, far, far more important issues to discuss than whether PTs should have direct access.
Do not forget that we have all been in hospitals where incompetant people (from all disciplines) were allowed to continue practicing. Where clinicians don't even wash their hands. Just look at the way LBP is treated. In many cases, it borders on criminal. I still know practicioners that fuse just about every patient that comes their way.
PTs seeing a few patients off the street seems to be a minor issue.
mcap
|
|
|
|
|
Re: compromise of direct access campaign - July 11, 2004 6:29:00 AM
|
|
|
Diane
Posts: 1507
Joined: March 9, 2001
From: Vancouver, B.C., Canada
Status: offline
|
[QUOTE]PTs seeing a few patients off the street seems to be a minor issue.[/QUOTE]Ditto that mcap
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
 Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.125
|
Printable Version
All Forums >> [RehabEdge Forum] >> Open Forum >> Re: compromise of direct access campaign 
