Need some help with PTA vs ATC in clinic (Full Version)

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sarty -> Need some help with PTA vs ATC in clinic (September 8, 2001 12:53:00 AM)

I work with an ATC. My facility is one that focuses on injured workers, so there is a multi-disciplinary approach to the patient's care, with access to PTs, PTAs, Vocational Counselors, and a Psychologist for pain management and coping skills. The athletic trainer in our facility works with patients basically in the same role that I do as a PTA. The PT evaluates the patient and then the patient has appointments with the athletic trainer (well, all patients except Medicare and Tricare clients). The PT supervises her as they do me.

She has produced a study (I haven't seen it) and given it to our director stating that ATCs get better results than PTAs.

In our official department chain of command, she is placed below the PT and above the PTA. The PTA is listed as equal to the tech/exercise specialist.

Needless to say, this whole situation concerns me on many levels.

I wrote to the APTA a month or so ago, just to ask in general about the ATCs role in the clinic, and they replied that patients coming in to see the ATC as their physical therapy provider was not acceptable.

What is your opinion on this, first of all.
Secondly, do you know of any research, case studies, etc that address the efficacy of PTAs (with or without comparing them to ATCs)? I feel compelled to present my director with some sort of documentation supporting myself.

This particular ATC is very vocal about athletic training (which is fine), but she says things that, quite frankly, strike me as unprofessional and downright rude, such as "I always think of Athletic Training as "active therapy" and Physical Therapy as "passive therapy". And since she has been with the department quite some time, this is what the other staff members, our director, and the patients are beginning to believe.

Any tips? Any help? Any Valium? (Just kidding!) [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]

Thanks,

Jen




BEA -> Re: Need some help with PTA vs ATC in clinic (September 9, 2001 6:38:00 PM)

It is really sad that PTAs are not always seen as a valuable resource. I think that this field has become more divided over the years. I feel that at your facility if the ATCs are more accepted by the patients then the PTA then you have to see how your facility is presenting their PTAs. I worked in a facility for 7yrs as a PTA and when we were introduced as staff from the PT dept. For some reason some people don't want an assistant treating them or their child because being an assistant you are less then. I know many assistants in both the PT field and OT field that can give most of their supervisors a run for their money on hands on knowledge as well as book. In my facility we presented the clients and their familis with a team working to treat their families and we let them know that this person was best in what they need. But we all knew what we were able to do and not do. Our supervisor was not threatened by what we knew and we respected our role with our job discription.

It really hard for me to imagine working at a place were I felt that my patient and co-workers looked on at me as less then.
[IMG]http://www.rehabedge.com/forums/frown.gif[/IMG]


[This message has been edited by BEA (edited September 09, 2001).]




ptbiker -> Re: Need some help with PTA vs ATC in clinic (September 9, 2001 7:39:00 PM)

I have worked with excellent ATC's in the clinic in the past but I have come to believe that they have no place in a PT clinic. My rationale is simple. In my state ATC's are do not have a defined state practice act. Therefore the rules that define the practice of Athletic training here are those of the National Athletic training Association. Their rules state that ATC's are to be supervised by a physician ie. a PT is not authorized nor qualified to perform their supervision.
Additionally it would seem unethical at best and illegal at worst to bill for Physical Therapy when the patient is not receiving PT. This leads to the question of what is PT but that is for anouther post.
Bottom line while ATC's in general may have excellent skills they do not belong in a PT clinic. Additionally the specific ATC in question is clearly undermining her coworkers and presenting an incomplete picture of what PT encompases.

Lastly one credential that is common to both PT's and ATC's and which would be very valuable in your setting is that of Certified Strength and Conditioning Specialist.

Good Luck
Jim




Jeffrey Ziblut -> Re: Need some help with PTA vs ATC in clinic (September 9, 2001 8:17:00 PM)

When i worked as a student i was in the clinic with ATC's. From what i know (i was educated in NY) most insurances won't pay for services performed by an ATC. Here in FL all ATC's require a co-sign from a PT but the PTA does not alway require it. It depends on the insurance carrier. The ATC's that i worked with did mostly what was assigned to them by the PT. In many cases our ATC's were contracted out to local highschools during athletic activities and their patient load consisted mostly of those kids that they worked wiht on the field. I do not think that an ATC should be able to treat in the clinic with the same rights as a PTA. I at least know that my PTA has received a standard amount of education and has a working knowledge of what is going on in a clinic. As far as this ATC refering to PT as "passive" and ATC as "active" she is dead wrong. IN my daily practice i utilize exercise and mobilization as my mainstays. I rarely utilize ultrasound and e-stim. I have found (as have many research articles) that manual therapy and S.T.E.P. are much more effective than modalities. In my opinion a PT who simply uses modalities is passive, but a PT who is properly educated and maintains a continuing education program could never be accused of being passive. I allow the PTA to do everything i do except perform evals, discharges, mobs, and change programs. They are very competant in the fundamentals of STEP. My thesis involved manual therapy, outcomes, research, exercise and several other topics and my research uncovered many instances where a combination of mobs and STEP were the most effective form of therapy. An ATC cannot legally perform controlled passive movements (mobs) and neither can a PTA, but a PTA and PT teamed up could produce the most effective outcomes.




sarty -> Re: Need some help with PTA vs ATC in clinic (September 9, 2001 10:10:00 PM)

Thank you all for your replies.

I have a specific question for the last poster how mentioned they worked in Florida. I work in Florida as well, and I was not aware that ATCs required a PT co-signature. I've looked through the FL statute 486 and didn't see it, but that is the only place I know to look. If you happen to know where that is documented, that would help me greatly.

Thanks so much!




Ron -> Re: Need some help with PTA vs ATC in clinic (September 10, 2001 9:30:00 AM)

Well your question brings up many of the issues that face our profession. I have been in this well over 20 years and I have slowly seen our professional status dwindle to, sad to say, bickering between who is better PTs, PTAs, ATCs, techs for that matter, egads! give me a break.
The correct and legal answer to your question is that the ATC functions as a tech within the code and billing restrictions currently on the books. The only exception is if your state law allows ATC's to bill. Now to who is better, the answer does not lie in the letters after the name but in the hands to whom they are attached. I employ many ATC's who provide great care, I employ PTAs who do likewise. Our team approach provides a great product. I am not sure I see the benefit of "comparing" care givers, particularly in the same department. Everyone who looks to provide excellent care should be willing to teach thier peers as well as learn from them. As far as the passive versus active statement, I would suggest you take that one head on. This is clearly a misrepresentation of our profession and our skills. Proactive approach to care, aggressive interventions and instructions should be the hallmark of every treatment plan. If your director supports the passive theory, look for another job!!!




mcap -> Re: Need some help with PTA vs ATC in clinic (September 10, 2001 11:04:00 AM)

Ron:

I agree with you. The turf war debates can get tiring.

However, there are places where ATCs are pushing for primary rehabiliative professional status. In other words, you would be able to go to an ATC with a Dr.'s Rx instead of a P.T. I do think this is a problem that could be disasterous for our profession.

The driving force behind some of this legislation are companies that would love to hire ATCs at lower salaries than P.T.s

As to who is more qualified......well....within our profession we have many that are ATCs as well. I would ask them as to who is better suited to be a primary rehab provider.

mcap




sarty -> Re: Need some help with PTA vs ATC in clinic (September 10, 2001 12:24:00 PM)

Thanks again to all that have replied.

In reading some of the replies, I wanted to make sure that I came across clearly. I am not personally trying to prove that PTAs are 'better' than ATCs. I just felt the need to provide some documentation to my boss about the efficacy of PTA treatments, and also to make sure that all the laws are being followed/ethics being upheld in this situation.

Sorry if I came across any other way.

Thanks again,

Jen [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]




charanderson -> Re: Need some help with PTA vs ATC in clinic (September 10, 2001 12:32:00 PM)

From a practical standpoint, I would ask myself, if I were you, do I want this job? Could I get a better job, with more respect at another facility? Are my skills where they need to be to get the kind of job that I want?
If there are generally better jobs with PTs that are respectful of your PTA role, then I would make sure that your skills are as sharp as they can be, maybe find some good courses, then apply.
If this is the best job for miles around then know that you may very well have a frustrating up hill battle informing and enlightening them on the differences of legimate Practice parameters. To do so may even threaten your job. In the working world, if you act as if you are in a righteous battle, you will risk loosing big, even if you are right. The ATC, as you said, has been there a long time. I imagine that the ATC is older, maybe even has longer established relationships with the other staff.
If you decide to stay, and would like to increase your level of respect and the respect of PTA's I would recommend an indirect approach (don't attack the issue of PT co signature.) I recommend that you offer to your Director, to do inservices on various topics that you are well informed on or are interested in learning more about. Maybe become very active in local activities that use your skills and help the community.
These things would be win-win for now and your future.

Good Luck,

Charlene Anderson, P.T.
[URL=http://www.SmartTiming.com]http://www.SmartTiming.com[/URL]




RehabEdge -> Re: Need some help with PTA vs ATC in clinic (September 11, 2001 8:00:00 PM)

The following Post was sent to RehabEdge via Email:

This issue of ATCs working with patients is not new. In years past, I have
been present at an APTA's Board of Directors meetings and House of Delegates
Sessions in which this topic was debated thoroughly.

One thing that must be remembered is that state law governing the practice
of physical therapy takes precedence! These laws will vary form state to
state and from region to region. Some states do not allow anyone other than
the PT and/or PTA to provide direct patient care. Other states have varying
degrees of supervision requirements of the PT aide by the PT.

Information regarding legal requirements for PTs/PTAs in any state can be
accessed via the Federation of State Board's web site: [URL=http://www.fsbpt.org]http://www.fsbpt.org[/URL]
by clicking on the link to Directory of State Boards then following the
links to the state of your choice.

The American Physical Therapy Association's Policies and Positions regarding
physical therapist ethical responibilities and currently adopted
professional standards for PTs, PTAs, and aides can be found via the APTA's
web site: [URL=http://www.apta.org.]http://www.apta.org.[/URL]

In Alabama ATCs who provide physical therapy services are considered to be
physical therapy aides and are subject to the same restrictions as a PT aide
would be: on-thejob trained by a physical therapist with supervision of
techniques or procedures they provide being "direct and onsite" by the
physical therapist and/or the physical therapist assistant.

ATCs are also licensed here in Alabama and are therefore subject to the
legal restrictions of their practice act.

In my personal opinion, ATCs are very qualified to work with athletes who
experience sports injuries. Many ATCs are also highly qualified in other
areas and may even possess a master's degrees in science/exercise
physiology. Some of them I know personally are very caring people.

However, I do not believe the ATCs education/training currently provides the
background needed to work with persons who may have underlying pathology
and/or functional limitations. I personally know of a situation in which an
ATC was providing "rehab" to a friend of mine for a torn ACL.

This friend just happened to have had a heart attack several years
previously (at age 45) and had undergone subsequent bypass surgery. When my
friend described to me the type of treatment she was recieving I asked her
if the ATC knew her limitations and she replied that neither he, nor the
PT, had asked.

She was experiencing shortness of breath during excercise and other symptoms
that would have prompted a PTA to request the PT to do a
re-evaluation/revision of the Plan of Care. This ATC, however, was telling
her she needed to "work through the pain." In essence, he was reating her as
if she were a conditioned athlete! At my urging she informed the physical
therapist who then took over her care.

Problems, and resulting liability for the physical therapist, with ATCs
providing physical therapy procedures do occur. This may be due but not
limited to any/all of the following reasons:

1. ATC's lack of educational preparation in working with persons with
pathology or functional limitations.

2/3. Lack of on-thejob training in the specific procedure delegated by the
physical therapist; Lack of sufficient on-the-job training by the physical
therapist(s) who delegates patient care/supervises that care

4. Insufficient, illegal, unethical supervision of the ATC by the PT and or
PTA where allowable by law

The list could go on and on. If you do not have a copy of your state
laws/rules and regulations governing physical therapy and the ethical
requirements for PTs and PTAs, I suggest you obtain them as soon as
possible!

Jeannie Box, PTA, ACCE
Jefferson State Community College
Physical Therapist Assistant Program




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