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Re: CA DC's do "physical therapy"
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Re: CA DC's do "physical therapy" - March 29, 2006 12:40:00 PM
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chiroortho
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Come on back off.
I can't imagine why as guests on a PT forum that we DCs wouldn't expect some resistance on this topic.
Why not move on to a more useful dicussion?
PTs are the rehab experts. Some DCs do a good job at rehab. DCs are the manipulation experts. Some PTs do a good job at manipulation.
Wow this is an old, tired discussion.
To my DC colleagues: we are guests here. Why argue with our hosts? What do we expect to prove?
Greg
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Greg Priest, DC, DABCO
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Re: CA DC's do "physical therapy" - March 29, 2006 12:41:00 PM
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TLB
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[QUOTE] Not for even a New York minute do I consider that I am showing disrespect to a PT [/QUOTE]Actually your showing disrespect towards the profession in general. ,maybe not intentionally but it is still disrespectful. I would never tell a pt. or whoever, I think we need to do some chiropractic on this guy. Modalities are modalities and nothing more, they are not physical therapy and should not be referred to as such. I understand in chiro school that is what they teach but that doesn't make it correct.
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Todd
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Re: CA DC's do "physical therapy" - March 29, 2006 12:46:00 PM
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chiroortho
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That's fine Todd. I do not see how arguing the point with you or anyone else would be useful. If I were a PT I'd say the same thing.
I've endured a few PTs coming to chiroweb that have attacked DCs intelligence, etc. I don't generalize that to all PTs. Manipulation is the bailiwick of DCs and DOs. Rehab is the bailiwick of PTs. There is some overlap. If you want to say you do chiropractic manipulation then get your board to agree to that. I didn't write the chiropractic board nomenclature of therapeutic approaches.
The turf wars (that's all this amounts to, isn't it?) will continue. As for me I'll continue to learn from PTs about rehab and move on from there.
I feel like a grandmother telling the grandkids to chill out.
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Greg Priest, DC, DABCO
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Re: CA DC's do "physical therapy" - March 29, 2006 12:50:00 PM
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TLB
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Greg,
I'm just trying to get you to look at things a little differently then how you were trained and your right if you were a PT you might see things a little differently. Anyway I need to go, I've got to do some chiropractic on a patient. :) :)
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Todd
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Re: CA DC's do "physical therapy" - March 29, 2006 12:54:00 PM
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chiroortho
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One thing all of this says to me is that manipulation is useful under certain circumstances.
I'm okay with that.
Greg
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Greg Priest, DC, DABCO
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Re: CA DC's do "physical therapy" - March 29, 2006 2:38:00 PM
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UTDC
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In reference to why chiropractors feels the way they do toward the term physical therapy, it is important to remember that DC's:
1. Take classes called "physical therapy"
2. Take board exams for "physical therapy"
3. Have many state practice acts that refer to the term "physical therapy"
Now, if chiropractic was not a protected term (which physical therapy is not in most cases) and PT's had "chiropractic" ingrained in their profession as above, I would not be surprised to see PT's doing the same.
As has been stated, this topic has been covered before and it is doubtful that much clarity will be gained here. I do believe, however that it is important for both sides to take into consideration the others point of view.
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Re: CA DC's do "physical therapy" - March 29, 2006 3:14:00 PM
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TLB
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UTDC,
Your wrong about physical therapy not being a protected term in most cases. This was taken from the PT Bulletin.
"In 1971, the American Medical Association (AMA) finally dissolved the American Registry. Former APTA President Charles Magistro, PT, FAPTA, says, "Without licensure, we would have been doomed. It is only through having legal status that we have had a foundation on which to stand in so many of our battles and subsequent victories for the profession." Most notably, state practice acts and licensure have protected the term "physical therapy," allowing PTs to halt efforts by other professions, such as chiropractors or massage therapists, who have attempted to claim they provide "physical therapy" and to bill insurance companies for "physical therapy."
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Todd
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Re: CA DC's do "physical therapy" - March 29, 2006 5:26:00 PM
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hmgross
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Greg
Try this: This patient needs PAMs-- takes only a fraction longer to write and doesn't confuse anyone with the profession.
Why is this such a sticking point???
I certainly don't write "needs chiro for L4-5"
Several years back, OTs in Minnesota started taking CE classes in physical agent modalities and I don't recall ANY of them referring to what they do as PT. It really is time to get on the same page.
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Holly Gross PT
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Re: CA DC's do "physical therapy" - March 29, 2006 6:15:00 PM
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chiroortho
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Holly I don't want to argue about this. Suffice it to say that I understand your concern.
Greg
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Greg Priest, DC, DABCO
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Re: CA DC's do "physical therapy" - March 29, 2006 9:41:00 PM
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DC_Student
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Greg,
In all seriousness, you defended that southern state chiropractic board in their lawsuit against the PT for his manipulation.
I advised that this was a bad strategy because chiropractic needs to expand to survive. Recall that I said that chiropractic was , once again, circling the wagons to protect a near worthless patch ground....That it needs to build bridges instead of walls.
But now that they went through with it, there is no reason to expect PTs to act differently.
PTs now should justifiably sue the California state board...
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Re: CA DC's do "physical therapy" - March 30, 2006 2:02:00 AM
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SJBird55
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Since I'm the one that did bring up chiropractors billing out for physical therapy in the demonstration project... as I said, I just glanced at it and saw the words "physical therapy." Rick is correct, if physical therapy is truly going to be provided, as of July of 2005, the chiropractors in that demonstration project do need to have a physical therapist providing care. And, I do think that it would be a lot more simpler to say physical medicine modalities or modalities.... physical therapy is a whole lot more than just those modalities.
If the chiropractors in the demonstration project DO provide physical therapy to patients (without the appropriate personnel), well I believe they need to fill out an NEMB (I think) and communicate to the patient that the benefit is not covered because the service is not being provided by a physical therapist.
It was just the fact that they (CMS) called it "physical therapy" which did feel inconsistent to me. I'm glad Rick clarified that a PT would be required to perform physical therapy....
Technically, I'm really not sure on the definition of the CPT codes. The language does state "physician or physical therapist" in the definition of who is able to provide those codes. CMS does not include chiropractors as "physicians" in their definition of "physician." I have no idea who the AMA includes in the definition of "physician." So, realistically, there may be an issue with chiropractors using the physical medicine codes IF chiropractors are not considered physicians by the AMA. That I don't know. I have a hard enough time worrying about myself.
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Re: CA DC's do "physical therapy" - March 30, 2006 3:22:00 AM
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FLAOrthoPT
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I may be totally wrong, Greg please correct me if I am. But I think the BIGGEST difference in outpatient orthopedics between DPT and DC is our in depth learning and studying and diagnosing and treating of motor control. From the spinal pathways, itrafusal fibers, through what it actually means in a functional level and treatment paradigm...I think we as PTs spend more time on motor control. Be it the integration of motor control to learn a new task, sports, stroke rehab, integrating a RTC back into mass patterns of the body, etc. I am pretty sure any decent chiro can do therex, but do they look at the progression the same way we have been taught from a motor control perspective?
I think that a guy coming in with knee pain may be treated the same as far as "rehab" goes by a PTA or a DC. But I think that looking at the whole kinetic chain, thinking about foot biomechanics, pelvic motor control and mechanics, eccentric hamstring control, patellar tracking, lumbar range, etc, that whole global approach is what our profession stands on. I think the actual intervention of therex or whatever we choose to integrate may be up for grabs, but knowing which tool to grab out of the box, when, and why may be what sets our approach apart.
The same way that any PT can be trained to manipulate, but it is the knowing of when, how, why tha makes it a skill rather than just doing an intervention. Granted some DC out there, on here, have totally demonstrated a vast understanding of these issues with respect to rehab, but I think in our rudementary schooling that we get in our initial entry level portal, we as PTs are more qualified for treating these issues which all come down to motor control, and DCs are more adept at an entry level portal in performing spinal manipulation.
The biggest complaint peopple seem to have is the DC population claiming to do PT based on a couple of tools we have, when it is our ability to diagnose these motor control issues and create an effective treatment plan that truly IS PT, not the tool sin the box, it is the person carrying the box. That is where some of the anomosity is I think. Of course any person can be trained in a small time to do modalities, therex, core stab, etc. But that in itself is NOT PT. It is the constant evaluation and re-evaluation and subtle changes to a program to see that a patient is recovering to be able to use said injured part in as normal as possible, efficient motion specific to their activity.
I am not sure if this clears up some of the walls that are being put up, but it is the deep inner feeling I think. That our vast knowledge cannot be summed up by our intervention techniques. We are not limited to any one modality, any opne therex, any specific setting, any specific patient population. We as PTs are trained to treat motor control issues anywhere from pediatric developmental patterns to sports injuries to sports performance enhancement, to rehabbing an ACL on a school teacher, to stroke and neuro rehab, to treating burns and wounds, to geriatric rehab, to home health, to hospital work, to the school setting etc.
It is patronizing for ANY OTHER professional to claim they are doing "PT" when we spend no less than 7 years working towards that specific knowledge base. I feel that anyone claiming to do a specific intervention technique is justified in learning to do such an intervention, but to call one or many PT tools the sum of PT is just insulting, and therein lies the big issue we see on here.
Without going through our schooling it is tough to just say you are doing our profession. I can see conversely, you do not want a PT doing chiropractic medicine. Well, we DONT. We never have said we do. If manipulation is all that you guys have, than maybe we do, but I am sure there is a philosophy of diagnosing and treatment you all have that we do not perform. That is what chiropractic is, the whole philosophy, NOT just the manipulation. Anyone can be trained to use that tool of manipulation. I think that some of our interverntions overlap, which is no big deal. Some of our interventions overlap with OT and ATC and LMT, no big deal, but an ATC and LMT can never amount to the vast training and knowledge I have received.
So this whole turf war is ridiculous, so let's stop. DCs must have some whole paradigm of a profession they stand to, and we as PTs have our whole paradigm as well. But to call anything anyone besides a PT does, "PT", is as ridiculous as we PTs caling anything we do "chiropractic". Let's just admmit and understand we have some overlapping patient populations and diagnoses we treat with similar interventions, but overall our approach is most likely different, which make sour professions unique.
So I hope this clears up for some non-PTs and maybe some PTs, why it is just not right to call anything anyone besides a PT, "physical therapy." Some other professions use therapeutic interventions that we share in common, but not physical therapy.
OK, need to get to work, sorry for the rant, I didn't get enough sleep.
Ben Galin, MPT,OCS
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Re: CA DC's do "physical therapy" - March 30, 2006 5:18:00 AM
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Lehmkuhler
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SJBird;
DC's ARE considered physicians by CMS. To the AMA, DC's are probably considered a thorn in their foot...
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Re: CA DC's do "physical therapy" - March 30, 2006 5:50:00 AM
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Dr.Wagner
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Let me tell you without hesitation, without attempting to offend my chiropractic friends, DC's are NOT considered physicians by anyone but themselves. Moreover, they have had to politically fight to be called such, and therefore ONLY in certain states may they use the name reserved for the MDs/DO's that earned the name physician.
In no way shape or form, will I consider a DC a physician...that does not take away from their expertise in manipulation or manual techniques of the spine or extremity.
To MDs and DOs the term "physician" is virtually a sacred term reserved for those who have spent countless hours in medical school and in the hospital. The term "resident" comes from the "living" in a hospital by new docs.
When one speaks of the "Columbia University School of Physicians and Surgeons"...they aren't talking about chiropractors. You can battle political nomenclature as much as you wish...but that doesn't make you a true "Physician". Sorry
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: CA DC's do "physical therapy" - March 30, 2006 6:05:00 AM
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chiroortho
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Hey Ben I agree with the tone and content of your post. Specifically I agree that PTs are WAY ahead of DCs in their training of 'motor control' issues that you present.
That's why I refer my patients to PTs for this.
I agree with just about everything you said bud.
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Greg Priest, DC, DABCO
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Re: CA DC's do "physical therapy" - March 30, 2006 6:08:00 AM
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chiroortho
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DocWagner I have no bones to pick with your post.
I guess it's just not really an issue on my radar screen.
I'm just trying to be a good dad to four kids. That gives me enough to think about.
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Greg Priest, DC, DABCO
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Re: CA DC's do "physical therapy" - March 30, 2006 6:14:00 AM
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chiroortho
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Something to think about folks - I've said it here and elsewhere, and I'll say it again - rise to the top of your own profession. Get all the education and training and certifications that you can. Focus on your own professional expertise, and rise to the top of your OWN profession.
That was my goal ever since I was a student, even before. I always wanted to be at the pinnacle of whatever field I chose to pursue. I set my mind to it, pursued it, paid my dues.
So it doesn't matter what I or any other DC thinks about PTs/MPTs/DPTs. If DPT is the highest level of training in the Physical Therapy world, there is absolutely no doubt in my mind that if I were a PT I'd be enrolled in a DPT track.
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Greg Priest, DC, DABCO
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Re: CA DC's do "physical therapy" - March 30, 2006 6:26:00 AM
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Lehmkuhler
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The question was whether CMS considers DC's physicians. I made no other claims. But I think I did unintentionally strike a nerve.
Sorry to offend your holy sensitivities...
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Re: CA DC's do "physical therapy" - March 30, 2006 6:47:00 AM
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JDMBBuilder
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FLAOrthoPT
that was a good post...well said
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"Anyone can throw you on a "state of the art" machine and call it physical therapy. The only high-tech equipment I need are my brain and two hands..." -JSDPT
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Re: CA DC's do "physical therapy" - March 30, 2006 7:00:00 AM
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Dr.Wagner
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I am in no way intending on offending anyone at all...I am simply making a point...I would imagine the same way most hold the title their profession close to their heart.
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