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Re: Will PT salaries increase?
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Re: Will PT salaries increase? - September 4, 2006 10:45:00 AM
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proud
Posts: 920
Joined: March 22, 2006
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KARIE,
proper nutrition is not "pseudo-science". Of course not. and I agree that many of our clients could stand for some education on how their problems may be in part a result of poor diet. That is not exactly coming from out in left field really.
And Karie, I am confident that what you call "works" is unfounded with basic principles of science applied. Just an opinion based on my research and time spent reading. Illness behavior being the variable I think you will discover is what all these funny treatments are in fact influencing. Unfortunately, this is likely depriving many clients of the help they truly require.
As always Karie, one of us will be proven wrong through research. But is that not the point of all this?
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Re: Will PT salaries increase? - September 4, 2006 11:21:00 AM
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rwillcott
Posts: 395
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From: Canada
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Karie,
With regards to CST, insurance is most definetly the issue. This is not a technique that should be billed under the umbrella of Physiotherapy. There is no evidence to support CST. Period.
These are excerpts from a well written letter published in Physical Therapy 2002. Here is the attachment:
http://www.ptjournal.org/cgi/content/full/82/11/1146
The Insurance Corporation of British Columbia concluded that "no plausible functional background and no empirical evidence of effectiveness of craniosacral therapy could be discerned from the materials reviewed."(Oppel et al, 1997)
In 1998, the National Council Against Health Fraud concluded that "cranial osteopathy is more a belief system than a science." (Cranial Manipulative Therapy: Information for Prudent Consumers From the National Council Against Health Fraud Inc., 1998)
In 1999, independent reviewers "found insufficient evidence to support" or "recommend craniosacral therapy to patients, practitioners or third-party payers for any clinical condition." (Green et al, 1999)
In fact, if you read the attached letter, this can be considered fraud if CST is billed as Physical Therapy.
I have no objections if a PT chooses to study CST and call themsleves a certified-CST and the patient pays out of pocket. The problem is when PT's bill CST and other alternative techniques as Physical Therapy.
Cheers,
Rob
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Re: Will PT salaries increase? - September 4, 2006 11:45:00 AM
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Karie
Posts: 107
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From: Wisconsin
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rwillcott,
I will review your reference, but to the allegation that I am committing fraud....I have written authorization from the insurance companies that I bill for it in this country, be careful when you tell some one they are committing fraud, that is slander in this country.
Cheers to you!
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Re: Will PT salaries increase? - September 4, 2006 11:48:00 AM
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Karie
Posts: 107
Joined: August 14, 2006
From: Wisconsin
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Just checked it, already have that one in my pile that I am working on for my response in the CST site.
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Re: Will PT salaries increase? - September 4, 2006 12:33:00 PM
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proud
Posts: 920
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Karie,
I think you and any other indviduals who performs CST, or claims to mobilize visceral intaglements and then bills it as PT, may be the one concerned about legal action.
Mr. Willcott simply presented information. And pretty important information I might add.
If you choose to ignore it, I truly have cause for concern.
Most highly respected PT's that I know have told me not to waste my energies fighting this sort of clinical behavior. I think it is the required duty of PT professionals to speak up. I don't imagine any evidence to the contrary will convince you Karie. My hope in voicing my concerns is that any impressionable PT or new grad who reads here might get the take home message( if they did not already while in something called university).
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Re: Will PT salaries increase? - September 4, 2006 12:55:00 PM
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Karie
Posts: 107
Joined: August 14, 2006
From: Wisconsin
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Proud,
I don't negate anything when it comes to legalities. I don't take kindly to being told I am committing insurance fraud when I have authorization from the insurance companies that I bill it to, in writing that I can do so. For those that don't allow it, the patients are billed privately for that portion of their treatment. You see I don't only treat with it, it is a tool in my rather large bag.
On the other hand I do think there are alot of therapist's billing insurance companies for it that don't pay for it and creatively call it other things. That is fraud. Then I am in agreement with Rob. There is a big political debate concerning fraud for Medicare in this country as well. Such as incident to practices etc....I am probably overly conscientious of legalities, one has to be when one is an owner.
Proud we depart on views of how we treat, but one thing we do agree on is that Physical Therapy has high value in the profession of healing and needs all the recognition it deserves.
I don't agree with new students being placed in a position to work with this type of technique nor others that have this much controversy until they have a firm foundation in the fully accepted Physical Therapy approaches and have alot of experience. Then, one can look at other avenues of treatment and determine with good solid background whether or not something has validity and is worth pursuing for them.
I am open to the idea that some other physiological construct may be producing the results I see than what I have learned, but to not treat with it when it is as effective as I have found it to be would be negligent for me. I can't withhold a treatment that I know will help.
I will speak to the literature situation on the CST post, hopefully within the next 2 weeks. I am still compiling a variety of background and pro/con research information.
This is my last post here, Cheers to all!
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Re: Will PT salaries increase? - September 4, 2006 1:49:00 PM
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proud
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Karie,
I am passionate about these topics because I am convinced beyond a shadow of a doubt that our professional future depends on this. And those who intend on having a 15+ year career in PT should consider this as a top priority. I have worked in both the US and Canada, two different health care environments for sure, both with similar problems containing "smoke and mirror" clinical tactics.
Given that PT's are the only specialists in conservative MSK management with university degrees, there is no reason why PT should not emerg as "the" principle clinical authority in this area. When you think of a total knee replacement, who do you think of? As it should be when someone speaks of back pain, or shoulder pain. First thing that should be associated in people's minds is the rehab specialists...PT's.
As it stands now, if I see a client who has severe back pain and a shift, and work on shift correction( a well researched technique that causes centralization and yes, pain), that client is so confused about who to see, he/she may abandon my approach( which would work and provide them with prophylactic measures for future recurrances), and go to a massage therapist. And what do you know!...4 weeks latter the pain subsides...only to return in 6 weeks or so.
Having PT's performing unfounded techniques that really anyone can learn at the local community college will only hurt our ability to advance and emerg as leading experts. In fact, if this association does not cease as soon as possible, we may see ourselves lumped in with every other "brand". What a shame that would be, and liklely the end of many careers as we needlessly battle for clients with massage, Aromatherapy, Chiro, Reikke masters, and yoda himself.
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Re: Will PT salaries increase? - September 4, 2006 3:19:00 PM
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dfjpt
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Proud, I have to agree with you on lots of issues. There is a Canadian board called Physiotalk that is set up to debate these important issues, definitely not as well attended as this board, but you are more than welcome to post there as well, start threads about the profession and where its boundaries should lie, how they should be defined, how you see the future of the profession. (You might even be able to generate a board renaissance.)
Meanwhile I can fully appreciate Karie's difficulty, the same many of us have, wanting to preserve, retain, repackage soft tissue work with an eye not just to improving function but also to relieving pain, the thing the patient cares about. The only way to justify soft tissue work from anywhere is to understand deep models of nervous system function rather than rely on superficial theories packaged in that have no construct validity, or just outcome studies. I mean, the Reiki practitioner might be able to show some pretty good outcomes too. Then what do we do? The underlying theory of the application must itself be valid before outcome studies will do us any good as a profession - that's what's missing, as Barrett Dorko has tried several million times to point out - PT, despite the fact that we are university trained blah blah.. actually missed the real boat, and has been pumped out into the world to function WITHOUT a proper grounding in or understanding of any biological deep model or even any real science context. Instead it grabbed a couple tools on how to measure this and that, and has jumped in, thinking, all right! we are science-based now by gee, this is great, we can "prove" that this works, we can "prove" that that works. Aren't we hot!? Guess what? We are likely to prove that not much of anything works and may go extinct along with chiros, if we don't refit the profession with deep models, particularly of pain and the nervous system. Meanwhile such models would take into accounts treatment effects observed empirically by people like Karie, even if the, um.. theoretical construct it came with isn't worth the powder to shoot a rat. She doesn't want to defend CST per se, only that when she handles peoples' heads they stop having pain and can go about life again. (Correct me if that's not right Karie.)
One last point, too many things are mashed together here: One issue is the political issue of carving out and defending a niche for the profession, fighting off the many pseudoscientific single-name "technique" promoters/cults that exist out there, who are the "competition."
Another issue is about who pays and how do we continue to make a living. They might seem related issues, especially in Canada right now, but really they are separate.
A third issue, more scholarly with less time pressure perhaps, which happens to be the one that takes up most of my time and life outside the clinic, is the "deconstructing" of all sorts of craziness and lack of construct validity in applications of hands-on work including that done by PT.
Fondly,
Diane
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Re: Will PT salaries increase? - September 4, 2006 3:28:00 PM
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Karie
Posts: 107
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From: Wisconsin
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Okay Proud, I wasn't going to post anymore but you are finally showing me some depth and honesty that I want to acknowledge.
I am so glad your passionate, so many are not, we agree there and please don't loose that.
I have watched over the years the profession loose what makes us the "experts" to other lesser trained professions. In my view, that is totally all of our fault who are part of the profession. We gave up exercise to the athletic trainers(not PT/ATC's just plain ATC) and personal trainers; we gave up soft tissue to the massage therapists; and we don't even seem to discuss nuero anymore (except here I see it in posts), whatever happened to Bobath/NDT-some new therapists look at me and say who and what is that? I feel like we were so embroiled in the chiro controversy/turf battle, and wanted to be recognized for our role in mobilization and manipulation that we just let all the rest slip away. Many may not agree, that's okay, that's my perception.
I do have problems with massage therapists going beyond their scope of practice and have discussed that with them when I learn of it and know them. The problem is in their schools; they are not drilled in the ethics and lines that they shouldn't be crossing. It's maybe mentioned but not emphasized.
What you should know too Proud is that many massage therapists are also degreed other professionals that got the massage therapy license to be able to directly treat patients. Hopefully, our direct access in states will eliminate the need for PT's to obtain a secondary massage therapy degree to treat independently. But, many have done that. That's a shame to have a PT go back and get a massage therapy license to treat. I know of nurses, OT's, and speech therapists who have done the same.
We do have alot of ground to make up PROUD, but I do believe our profession will survive working together.
Clients will come to you when they know you provide permanent solutions, they get tired of repeating the same old and getting no where at the other places. Be patient, they will return to you, all you have to do is provide the great skill I have no doubt that you possess.
Proud, with PT's like me, just be honest and talk from the professional/educational level that you have and then we listen. We can learn alot from each other when respect and honesty are shared.
I do wish you well. Look for my final post on the CST thread, it will probably be long.
I really wish you well and yes the research of the future will set the course. I am not worried about being right, I just want to help people get better and move on with their lives. I know you feel the same-we totally agree there.
Peace!!
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Re: Will PT salaries increase? - September 4, 2006 3:33:00 PM
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Jon Newman
Posts: 1697
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From: Amherst, WI
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Hi Proud (or other shift correctors),
What is the current concept regarding what a practitioner is doing when correction a shift? I honestly haven't kept up with this aspect and perhaps it will provide Karie (as well as me) with a more concrete example of what it means to have a solid foundation.
I'm still in disagreement with you (not that that has to matter really) on techniques (especially the level of complexity) being the important part of what makes PT, PT. Is it not possible to teach how to correct a lateral shift in a community college? In fact, are any of "our" techniques so complicated that they couldn't be learned at a community college or even a weekend course?
To my mind, it is not our techniques that make us the clinical authority in this area, it is our understanding--and the process of understanding is ongoing. In short, I currently don't think it is the variable methods PTs get their patients to their goals that is the bane of PT existence. It is the understanding (or misunderstanding) we leave our patients with.
_____________________________
[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? - September 4, 2006 3:48:00 PM
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Karie
Posts: 107
Joined: August 14, 2006
From: Wisconsin
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Hi Diane,
Just saw your post :-)
yes what you say is correct. Diane and Sarah are helping me to understand from a neuro prospective that I am not familiar with, why what I am doing is working and I fully embrace being made aware and learning that knowledge. I remain open and challenged, it's how I expand my potential to be better at what I do tommorrow than I am today.
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Re: Will PT salaries increase? - September 4, 2006 4:28:00 PM
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proud
Posts: 920
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Jon,
Well Robin Mckenzie himself ackowledges that anyone could likely apply his approach. But understanding the numerous variables involved in back pain makes PT the best suited to apply them(fear avoidance, the work of Jull, Richardson, Hides, Hodges, knowing what to tell patients and what not to tell them etc).
As far as the concept for doing shift correction: Donelson et al: A prospective study of centralization of lumbar and referred pain. A predictor of symptomatic discs and anular competence. This provides a reasonable construct for the technique. Add to that the numerous articles demonstrating its reliability.
This being the point: Shift correction can be explained(not perfectly) with some hard findings. CST on the other hand simply lacks this foundation.
To argue that patients get better and many people seeking this form of treatment out justifies it as a technique is unfortunate. Millions of people call 1-900 psychics but does that make it a worthy way to make your life choices? Well... I am not paying for my neighbor to make that call so whatever floats your boat. But the minute my telephone company charges me a surcharge for Psychic line usage fees...I have a problem.
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Re: Will PT salaries increase? - September 4, 2006 4:57:00 PM
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Jon Newman
Posts: 1697
Joined: April 24, 2004
From: Amherst, WI
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Hi Proud,
You don't need to convince me that the construct of CST is faulty and it sounds like Karie doesn't need to be convinced either. She's already moving toward trying to understand the outcomes she's observed--beyond that offered by her original instructors.
So the idea of correcting a shift is that you are making an incompetent annulus, competent?
Addendum:
Nevermind. I see the full text describes it as
[QUOTE]As long as the anulus and the hydrostatic disc mechanism are intact, however, an offset load on the disc in the lesion-specific direction of spinal bending can apply a reductive force on the displaced nuclear content, directing it toward its original central disc location. Such a reduction of displacement would alleviate stress on the symptom-generating anulus and/or nerve root, thereby centralizing and/or abolishing the pain, and identifying the patient's (or lesion's) "directional preference."[/QUOTE]Is this the most current explanation being offered to clinicians and patients that you know of? I'm quite familiar with this myself.
_____________________________
[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? - September 4, 2006 5:36:00 PM
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rwillcott
Posts: 395
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From: Canada
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Karie,
I aplogize if you took my comments personally. That's not what I intended. I am just trying to point out that there are PT's performing these alternative techniques and deciving both their clients and third party payers by calling it Physical Therapy.
We have so many treatment options to choose from before we have to investigate the use of CST. Especially with all the new research in classification systems of low back pain. With this new research we are on the brink of becoming the leaders in the treatment of low back pain. Amazingly, many PT's are not aware of this research! There is a window that has opened for us and we have to seize the moment before others try and claim this research as their own. The longer we spend performing alternative techniques the worse off we will be as a profession.
I too am passionate about PT as I can tell you are. We wouldn't be on this website if we weren't! I plan on working as a PT for another 25 years and I have to do all I can to protect our profession. I have begun to realize that I am part of a small percentage of PT's that are proactive and try to stay up to date on the literature. Too many have spent the last 15 -20 years applying passive modalities. This has set our profession back and we have to move fast to get back on track. Luckily, we have a new breed of PT's entering the profession and the sooner we get them into performing EBM the better off we will be.
This is merely my perception of PT. It's based on the region that I live in. Maybe the environment is different where you are. Once again, I'm sorry if you took my comments personally. That is not what I intended. I was just trying to make a point since I don't know how else this problem will be remedied before it's too late.
Rob
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Re: Will PT salaries increase? - September 4, 2006 6:03:00 PM
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Karie
Posts: 107
Joined: August 14, 2006
From: Wisconsin
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Rob,
I appreciate your reply and accept your apology. we are on the same team. I may be 46 but I plan to work a long time too.
My husband was in a converstation with a new engineer at work and this person was telling how his wife was going back to school to become a physical therapist. When pressed further on schooling he replied, it was only a year and would cost $10,000.00. To this my husband replied, I think you have the wrong title, to become a PT which is a doctorate now, takes alot more time and money than that. You can guess how much I was burning up when I heard that. Of course, she was training to be a massage therapist.
I am with you on honoring our professional intregrity, we will get there...together!!!
Karie :-)
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Re: Will PT salaries increase? - September 4, 2006 9:14:00 PM
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Randy Dixon
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Proud,
The business model I presented wasn't mine, it was that of private insurance. In an imposed system, such as Medicare or government funded system then utillization rates become the determnining factor. Where I believe PT has lost ground to alternative care providers is in following the Medicare model, to give patients solely what the provider wishes, or insurance allows. rather than what the patient wants. This may be acceptable, since it allows access to a much bigger pie. For those PT's that wish to not be controlled by the insurance companies though, a compromise will be necessary.
I find the spinal manipulation as the poster child for EBM interesting. Virtually every meta-analysis of it finds it to be ineffective or only very mildly effective. We have one series of studies, not duplicated, and done by the same researchers, with a very large effect size, showing manipulation to be effective in a subgroup of back patients. These are all red flags when using it as evidence. Bayes theorem and all that.
Diane,
While I agree with you that outcome studies are not the only form of evidence that should be considered in EBM and that the underlying theory of a technique should be examined, there is a reason why outcome studies come first. A "deep model" begins, no matter how it is worded, with "Given X" and then goes on to explain why X occurs. If X is just an assumption, not subject to an outcome study, then the deep model becomes an a priori argument. One which might make a lot of sense, but can never be proven or trusted. So "If" needs to be resolved BEFORE "why".
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Re: Will PT salaries increase? - September 5, 2006 4:20:00 AM
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proud
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Jon,
I am not your best resource on this as I am not DipMDT. Recently a DipMDT clinician posted here( John I think). Perhaps he is reading along and would like to comment.
In any case, yes I think that is the construct that is suggested in the conceptual model. As we can see in literature, that construct seems to have some level of support.
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Re: Will PT salaries increase? - September 5, 2006 4:23:00 AM
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dfjpt
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Randy,
There are already fields that have researched/are researching deep models to do with the human organism - they are already meticulously evidence based. Pain science is one. (Pain science should be central.) EvoDevo is another - no longer theory, it is the scientific basis upon which we should be standing, if we are a "science" that deals with the human organism, otherwise we are pretenders. It is where our bodies come from, how they take on substance, where they fit into all life. This basic understanding is not integral to our profession, not yet. What about psychology? There should be, if not immersion, then deep aquaintance with most of these. There should be immersion for sure in pain science.
PT at best flirts with deep models, skirts over them lightly, ("Oh ya, I remember we learned something about that in school.. one or two lectures.."), forgets all about them as soon as possible in the headlong rush to learn the symbolic language of biomechanics, refuses to speak any other language from then on, or base its "science" on any other foundation. Too narrow. To do that is to limit our potential drastically - PT panders to/tries to please insurance masters with smart efficiency rather than broadening out its base of wise understanding of what and who we really are as a profession, what we really can do here in the world of people and pain. As someone who long ago fired all insurers, I see this rush to make science projects to please outside authority instead of to learn to stand on our own merits as a bit sad.
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Re: Will PT salaries increase? - September 5, 2006 4:49:00 AM
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jbird007
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From: USA
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In all due respect, you PT's seem to worry way too much about what everyone else is doing. Many of you talk about "the competition" as if the others are your enemies. As a DC, I have great admiration for PT's but I focus my energies on performing practical and ethical chiropractic. I am not too concerned of "what the other guys are doing." I think I can speak for many other DC's which I have met over the years and they do not feel threatened nor are they competitive with the PT profession.
just my 2 cents.
JBird
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Re: Will PT salaries increase? - September 5, 2006 5:58:00 AM
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proud
Posts: 920
Joined: March 22, 2006
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Jbird007,
I speak for only myself but, when I speak about the "competition", I speak about it in that way to drive the message home( pocketbook seems to be the most understood tool), but it is not the deeper message I am trying to suggest.
The deeper meaning of it all is that the current system of conservative MSK management is failing. Everyone claims to have the answer, yet here we are with an ever increasing pool of patients with MSK isssues. It is the patients that are loosing at the end of the day.
In my mind the only way to imrove the care delivered to patients is to identify one group as the experts, make them accountable for their practices( PT has regulating bodies, but we are a long way away from properly regulating things...chiro even further away). In any case, This would eliminate the ongoing incorrect information that patients recieve. When I speak of eliminating the competition, I speak of eliminating the unfounded practices that exist. This I think is the way to go to improve patient outcomes. It may not be perfect, but I think it is the platform required to move the area of conservative MSK management forward.
You likely deliver care within the ethical and EBM boundries of Chiropractic care therby providing excellent care. However, the treatment options available now are far too varied. Some control measures need to be studied and subsequently implemented for the benefit of patients. Otherwise, we will continue with an ongoing epidemic of MSK issues. I just think there is a better way. And to me, a recognizable expert in the field is required( same as when you need a total knee replacement, we all recognize who the experts are in that area).
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