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Re: Will PT salaries increase?
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Re: Will PT salaries increase? - August 24, 2006 7:58:00 PM
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ONstudentPT555
Posts: 224
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Savela,
How do you think PTs are more strictly regulated? I thought here in Ontario chiros had more limitations for reinbursement from third party payers (caps on visits) and they were totally cut off from OHIP which I guess wouldnt really matter for most PTs in private practise but there are still some OHIP PT clinics out there.
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Re: Will PT salaries increase? - August 25, 2006 6:28:00 AM
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savela
Posts: 63
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From: toronto
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Yes we are more strictly regulated. I work with a great chrio and the only time he hears from his college is when it is time to pay his due's.
In this past year, I was randomly picked for a 4 hours audit of my practice with 2 assessors, and write an online ethics exam. We are now required to have a professional portfolio, which is time consuming and complicated. The manual how to make it, is about 80 pages alone and I attended a workshop also.
This is why my advice to you is ask questions before you take your first job. If you end up in a clinic that is not following the College's guidelines, they will act on it.
As for the OHIP question, the deregulation of Chiro's has not harmed the Chiro I worked with practice. OHIP was only paying a small amount of the fee and the patient had to pay the rest.
Most of the new grads comming out of the Canadian Chiro school take ART and Graston courses before they graduate. Many do not believe in the subluxation stuff and treat the same way we do. They are able to charge more because their College has no fee guide. I know of some that are charging $120/treatment.I hope this helps
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Re: Will PT salaries increase? - August 25, 2006 6:38:00 AM
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proud
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Savela,
I cannot be sure, but I think that how it works is that insurance companies figure out what their members want in a policy. That is indirectly tied with PT compensation I figure.
Which goes with my argument that letting the public choose what is covered has not resulted in better outcomes...in fact worse. Why is massage covered? Why is maintenance chiro covered? Because the uninformed public always look for the simple, and usually not effective, solution to their problem. Insurance companies want you to buy their product, so offer what the public requests. In the long run, they pay out more, and up their premiums to cover the skyrocketing cost.
PT's that practice properly and follow EBP, require participation in the solution from their clients. For the most part, people would rather listen to a chiro tell them that they can just lay their and get their "out of place" vertebrae replaced...once a week for the next 10 years!
This is not cost effective or beneficial in the long run. So I figure if these forms of practice( massage, reikki, CST etc) where eliminated from insurance policies, despite what the public wants, we would see PT emerge as the sole credable experts in MSK management. So long as we do not have PT's performing these bogus treatments. And in turn, an increase in compensation would result.
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Re: Will PT salaries increase? - August 28, 2006 2:52:00 AM
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Sebastian Asselbergs
Posts: 1106
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From: Barrie, Canada
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Sorry, folks. been away for a great few days with the family.
Yes, I am in Ontario private practice where most clients have insurance - but more than 60% of these have to co-pay. About 12% (haven't checked this years stats yet) are out-of-pocket uninsured patients.
And yes, I alluded to "you charge what you think you are worth" as a theoretical construct - first you need to prove that you ARE worth what you charge. Even IF you go outside the College "guidelines" - which IS an option - you would still be hard-pressed to get patients to get you the BIG salary. Simply because there is so lots of competition and little evidence for much of what PTs do....
Even as a unified group - which we aren't by a long shot - we have a lot of work to do to FIRST change a lot of practices in the money-making PT-mills, then expand the working-PT's knowledge and awareness of new research and implementation of that in practice BEFORE we can start to negotiate/charge bigger fees.
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Mundi vult decipi
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Re: Will PT salaries increase? - August 28, 2006 5:38:00 AM
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proud
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Sebastian,
I think your last paragraph was spot on. I guess that was part of my suggestion about a committee. In my opinion, as a collective group we need to establish improved practice guidlines(in Canada anyway). I just think that as patrons of EBP, certain "treatments" should not be billable as PT. Otherwise we cannot argue that we are any better than your regular run of the mill massage guy/gal etc. The thing that seperates us is our acedemic background and ability to understand research and it's implications on clinical practice.
QUOTE FROM MASSAGE THERAPIST PAMPLET IN MY AREA: "massage therapy is a hands on manipulation of soft tissues of the body( muscles, connective tissues, tendons, ligaments and joints) done with knowledge of anatomy,physiology and pathology of the bodies structures in a scientific manner for therapeutic results. Treatment procedures aim to rehabilitate, maintain and /or improve physical function and reduce pain and stress"
...this massage therapist states that "...done with...in a scientific manner for therapeutic results..." But do you suppose he/she really understands what that means?
So I think we need to understand that out PT degree is unique in that the best and brightest are meant to be accepted into our programs. If you choose to perform "treatments" without any scientific backing, that anybody with a 6-month community college degree can do, you should re-evaluate your choosen profession.
So I agree with you Sebastian about not being a unified group by a long shot. But what is the solution to that?
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Re: Will PT salaries increase? - August 28, 2006 6:41:00 AM
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dfjpt
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[QUOTE]...this massage therapist states that "...done with...in a scientific manner for therapeutic results..." But do you suppose he/she really understands what that means? [/QUOTE]I'm just curious Proud, how do you define a scientific manner or therapeutic results? For PT I mean?
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Re: Will PT salaries increase? - August 28, 2006 6:59:00 AM
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Jon Newman
Posts: 1697
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From: Amherst, WI
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Hi Proud,
I noticed the massage therapist did not claim to provide PT. I think that is an important point and I'll return to it in a moment.
Since our profession already teaches students to look at and interpret the evidence, publicly advocates evidence based practice and offers continuing ed. based on current evidence (not exclusively), and has a code of ethics that requires us to keep up with the evidence, what good would a committee be?
It won't change what the massage therapist advertises because that therapist cannot claim to provide PT--and it doesn't change that your tax dollars will pay for someone to receive a massage. It would simply limit what interventions a PT might offer someone. Yeah!
I don't get how that would help us at all.
Are you suggesting that a PT never massage a client at all? At what point does a massage become a massage? If I provide the best evidence based care and end with some massage can I call what I do PT?
What to do about not being unified? Public discourse makes much more sense to me than command from on high.
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Will PT salaries increase? - August 28, 2006 7:13:00 AM
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proud
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dfjpt,
Understanding EBP by being familiar with, and applying the ever-expanding body of literature in the form of RCT's,systematic reviews,meta-analysis, and clinical practice guidlines. I think the idea therapeutic results would be the same for everyone. Plenty of what Physio, chiro, massage, CST, can be coined "therapeutic". However the long term outcome is the important variable.
We all know that LBP has a natural history of improvement. Therefore, we cannot measure success by time taken to become painfree or by time taken to return to work.(Pain will resolve, but the low back PROBLEM has not resolved).
Best measure of sucess of an intervention= Reduce the rate of recurrence. We are becoming better at this through research.We need to understand the variables involved in chronic pain or pain in general( physical, psyhco-social etc) and apply that knowledge to proper patient management. I
It is not good enough to rub someone, manipulate someone and have their pain score go from 6/10 to 2/10 and claim that as scientific proof of success.
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Re: Will PT salaries increase? - August 28, 2006 7:39:00 AM
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proud
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Jon,
We must have been posting around the same time. I did not read your comments.
What you say makes sense. And I think you are correct in saying that we may just end up limiting ourselves. However, I think that is short term loss for long term prosperity( not to mention improved patient outcomes).
My point being that many many many people are claiming to have positive impacts on MSK issues( read my post above about where the evidence will, and is leading us about that).
I think I am approaching things from a procative perspective. Perhaps utopian, but I think the right direction to take. I feel that at some point, third party payers will want to clamp down on where they spend their cash. They will look at the EBP model to help guide them. So as a collective group, I think we will need to distinguish ourselves as "THE" practitioners delivering care in this manner. Does that make sense?
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Re: Will PT salaries increase? - August 28, 2006 7:55:00 AM
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dfjpt
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Proud, I think the public wants relief from pain. I think they want hands-on, most of them. I agree we shouldn't offer this under terms that are dubious, names of applications that have no construct validity and have always been associated with "spiritual" or "energy" type practitioners.
Instead I think we should use our science-based brain cells to work out what we can do to help patients the way they want to be helped, why they get helped, by how much they get helped, and not call what we do by these or any other bogus labels. Keep the babies, change the bathwater as required.
The only way to accomplish any of this is to learn from pain sciences, apply hands-on work that is congruent with what is already "known". Not believed. Adopt an ectodermal approach, not keep blinkers on and study the same mesodermal approaches over and over.
I hope by the time you get your committee together I'm long dead.
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Re: Will PT salaries increase? - August 28, 2006 8:01:00 AM
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Sebastian Asselbergs
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From: Barrie, Canada
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Proud, I think by taking our own practice under constant scrutiny, while communicating extensively with the referral sources (i provide refernces for any positive neuro-tests, since the GPs most often haven't heard of them) are places for each of us to start. You probably do this.
It is a long process, but more and more, doctors and ex-patients are preferring a few high intensity one-on-one, educational and very often hands-on sessions over the "usual bell-and-whistle" type PT clinic. This seems like a very slow process in a market where every day, a new marketing ploy is presented by the next pillow-maker, of-the-shelf-orthotic, lumbar support, supplement, drug, mattress maker, etc etc, vying for the "customer of health".
But I do think it has to be a grassroots effort - I can not see a "top-down" approach being healthy.
I speak at high schools at job fairs, with my fellow rotarians, with the docs at golf tourneys etc and insert my view of what I think PT in true EBM context really is (see all above rambles and on previous threads). And every patient and their parent/husband/wife can be influenced that way.
Well, ONstudent - a small look into the wild and woolley world of PT and its woes. How's that for alliteration?
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Mundi vult decipi
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Re: Will PT salaries increase? - August 28, 2006 8:01:00 AM
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drbuddy
Posts: 429
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From: Pennsylvania
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Proud,
You may want take note that almost every cost effectiveness study out there on chiropractic care has shown that including chiro benefits decreases costs.
http://www.ourchiropractic.com/costeffc.html
It is incorrect to imply that maintenance care increases costs because most insurance plans do not cover maintenance care.
It is incorrect to say that that most chiros tell people their problems are due to out of place vertebra. Some do, but many do not and include much more in their treatment approach.
I appreciate the pride you have in your chosen profession, but you can be proud without putting down everyone else. In my opinion, your problem should not be with the chiros that account for such a small percentage of healthcare costs, but with pharmaceutical companies and surgeons which cost much more. One surgeon probably accounts for more costs in one year than you or I could our entire careers. Not only does surgery cost a lot, but so does the myriad of expensive advanced testing and other procedures.
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Re: Will PT salaries increase? - August 28, 2006 8:23:00 AM
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proud
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Sebastian, I think you are going about it the right way. But I might say that most MD's do not REALLY care about EBP in our world. They just want to make sure that the patient goes "somewhere". Sounds like you do a great job of marketing PT and EBP. I hope that message comes loud and clear to everyone you come in contact with.
Dfjpt, I agree with every point you make. I gather you are not for a "committee" and I am not sure that I am either. It was only a way to generate discussion. You say "... I agree that we should not offer this under terms that are dubious or names of applications that have no construct validity and have always been associated with "spirtual" or "energy" type practioners..." But yet some do...so what do we do about that?
Buddy T DC, I think you are reading what you want to read in my posts. I never said ALL chiro's do only maintenance care. I never said that MOST chiro's tell their tell people their problems are due to out of place vertebra. I meant some do. I know that there are many excellent Chiro's. Those that understand and apply research etc... exactly the same standard I hold my own profession to.
And I do think manipulation( and I know good DC's do more than that...), can play an important role. Research tends to indicate in the acute phase really. But slowly we are learning that non-specific manips tend to generate similair outcomes to the so-called "specific" manips. So is it "chiro" manip that is beneficial? Or is it appropriatly identified sub-groups that benifit from non-specific manipulation...from a chiro, or a PT...
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Re: Will PT salaries increase? - August 28, 2006 8:32:00 AM
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dfjpt
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Proud, about PTs offering names of treatments that have no meaning in science terms: [QUOTE]But yet some do...so what do we do about that?[/QUOTE]Educate learn teach "deconstruct" educate learn teach "deconstruct" educate learn teach "deconstruct" educate learn teach educate learn... Sorry, I don't "know" of any other way.
Next after that: helping PT to wake up from the mesodermal coma.
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Re: Will PT salaries increase? - August 28, 2006 9:31:00 AM
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proud
Posts: 875
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dfjpt,
Fair enough. And I agree with you about education. So I also agree with Jon as well...we are taught about the importance of evidence in school. But apparently, a few either choose to ignore these basic principles of acedemic responsibility, or do not grasp the concept( how that happens I do not know).
Sebastian's "grassroots" concept is likely the realistic way to go. I do apologize for the rants. I tend to get frustrated when PT's in my area reduce my professional credability by ignoring basic principles of professional accountability to EBP. And my point for ONstudentPt555 being that credability will be the key to compensation increases down the line. Performing CST etc will not...
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Re: Will PT salaries increase? - August 28, 2006 12:11:00 PM
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james097
Posts: 178
Joined: January 27, 2005
From: West Vancouver BC
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Savela, you say your College (Ontario) sets your fee guide and you are required to follow. I thought a College is a regulatory body and is responsible for registration and licensing of PTs. A College should not set fees although they have the right to investigate where fees have been challenged by a patient. Should not the fees be set by the Provincial PT Association.
Jim McGregor
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Re: Will PT salaries increase? - August 28, 2006 12:48:00 PM
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Sebastian Asselbergs
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From: Barrie, Canada
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Jim, that is right. The College publishes the customary rates, WITH the caveat that level of expertise and geographical location are variables. The OPA actually sets the RANGE of fees, with the same variables. As long as the PT can reasonably justify the rate s/he charges, within those variables s/he can charge higher.
I can so understand proud's frustration - we did go through that here, but a few very good PTs have helped change the atmosphere in town, where the expectations of many (patients and doctors) are higher, thanks to a few persistent buggers....
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Mundi vult decipi
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Re: Will PT salaries increase? - August 28, 2006 1:01:00 PM
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Sebastian Asselbergs
Posts: 1106
Joined: September 29, 1999
From: Barrie, Canada
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.....and proud, I think that by writing to the different professional associations' publications: Physiotherapy Canada, Contact (in Ontario)and the Communique (Ontario College) may not move the earth, but it WILL bring discussion forth.
We recently (in the last year) had a rather lively discussion between letter writers about "alternative" techniques (CST, MFR) and Bahram Jam, PT, wrote a quite eloquent condemnation of these "energy-type" techniques.
Profound change tends to come slow, but we're at least seeing some debate about it - a heck of a lot better than 15 years ago!
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Mundi vult decipi
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Re: Will PT salaries increase? - August 28, 2006 2:15:00 PM
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proud
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Sebastian,
Yes, I posted to you about that particular condemnation by Bahram Jam. I used to work with a PT who wrote a letter to the ODR in that series of discussions about "alternative" practice. I think he shared my frustration and was willing to spend the energy and voice concerns. We need more solid clinicians with EBP in mind to become vocal. Where are they?
The scary thing about that letter writen by Mr. Jam was that( if I understood correctly), the CPA chose to ignore these concerns and continue to place ads for fairly off the wall continuing education courses. Perhaps a CPA represenative reads on here and might care to clarify?
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Re: Will PT salaries increase? - August 29, 2006 10:17:00 AM
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ONstudentPT555
Posts: 224
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How can a physiotherapist make very good money? I have thought about this for a while now...
This is what I have come up with:
Run a business.. it may be risky and you might fail but to suceed you have to take risks.
Be creative and Market, Market, Market, MArket, Sell your self and your business and this may mean marketing yourself against the competition like Chiro or not.. but business is business as long as you are ethical(which I think you have to be to survive with regulatory bodies breathing down our necks).. you need to have a business mentality.
I am still a student ..lol .. I got nothing to lose so we will see how things go.
Thanks for the discussion guys.
Take Care
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