Joined: January 31, 2005
It's so funny how every DPT thread ends the same.
Randy thinks we'll become physicians, with poor manual skills and afraid to touch patients; Wagner can't understand a degree unless it has a certain price to earnings ratio, and all the non-US PTs wonder what is up with the crazy Americans after all, and Ben gets furious with everyone and starts shouting. With such a wonderful formulaic post, we only need Drew to come in next and give us a good history lesson on doctoral degrees.
I have to say that I agree with PhysioG that it is definitely an American thing, and that it probably is mostly political. So what. If that's what we need to do (and evidently it is) then I guess that's it. As the popular saying goes, "don't hate the player, hate the game." Hate a system that would require a clinical doctorate to get better footing to start working toward more even-handed access and reimbursement. Read the Arkansas chiro transcripts, if you haven't already. One person arguing in front of laypeople is called "doctor" and one is called "mister". Who comes across better from the start? I don't agree with it, I don't think it's right, but there it is.
I think it is undoubtedly our future as well as the future for consumers who need access to a good level of treatment and diagnostic skill in musculokeletal and rehab medicine which other providers are unable to provide.
What happens to individuals during this transition is up to them. They can get on board, or not. I've no issue with those that choose not to. But we are training and developing a different level of professional now than we were even a few years ago. Our standards of practice and research are rising at faster rates than anyone else's.
A profession is more than what the medicare and ins company fee schedule looks like today. If all they can think of is that they won't get any more money, then of course it sounds crazy. If that is the depth of someone's concern, then they will neither enjoy nor see the value of further education.
ps Ben, the highest degree the profession offers is the PhD. Surely you're not suggesting that.
With your view of PT's, frankly I don't think we should be talking about DPT's for the profession, we should be talking about eliminating the profession. I don't share that view.
I believe it is arrogant and short sighted to assume that the DPT is the only way a PT can improve their skills or even that the DPT is a mark of a superior PT. You provided no logical argument or counter to others disagreement. An emotional rant insulting others and praising oneself isn't very convincing.
We posted at the same time. Just a clarification. My argument isn't that you won't have manual skills or that you will be afraid to touch patients. My argument is that the DPT is designed to add skills that will add value to what you will do. Providers practice at the highest level of value they can provide, which is why respiratory therapy, massage and other treatments are no longer done by PT. Wound care is in many places being done by nurses more than PT. In this case diagnosis and evaluation will be your most highly valued skill, that is what you will largely do, if not, then why pursue it further in a DPT. This will necessitate dropping some of what you now do as PT's today.
In other words, you only have so many hours in a day, if you add something to do, then you take away something else you can do. You should, and payors will insure, devote that time to providing the highest value of care to that patient. People with a Bachelor's are capable of doing what you do now, obviously. So they will handle that while you handle the things that DPT training is necessary for.
Joined: November 15, 2003
Just to add something else - PTs(PhD) have a lot of background knowledge and research experience, but it does not mean they are better clinicians than Joe Blow who is just a 'mister'.
What counts is the level of knowledge, and it must be knowledge relevant to the profession's advancement. One definitely does not need a PhD to be highly skilled and competent; acquiring new knowledge and chucking out the ancient theories is what really counts.
Joined: December 1, 2004
Jason, Could you direct us to those other threads discussing the DPT? I'm terrible at finding things on here, and I've lost access to the archives (darn Mac). My first impression is why are people so threatened by this whole DPT thing? I've heard PT's with Bachelors degrees insinuating that the new grads with DPT's will be trying to take their jobs or make more money, or expect to be treated differently. Where did this insecurity come from? Secondly, the t-DPT makes sense to me and I would've done it if it was offered at my school. Of course, I'm of the opinion that any learning is good and with more knowlege comes better critical thinking skills, understanding of the research and hopefully a desire to continue lifelong learning. What's wrong with striving to be the best professional one can be? And what's wrong with doing so in a formal educational setting versus self-teaching or continuing ed?? Not everyone is an autodidact. Thirdly, I am saddened by suggestions that all we do is stretch, mobilize, and walk with patients. Why have such low expectations of ourselves and our profession? So, we have nowhere to go but down? So that if we fall, we won't get hurt? I had a PT from another country once tell me that she didn't understand why we had to learn all the things we did in PT school, and that it isn't necessary to do the job. Well, watching how she practiced, I would agree. Personally, I would feel that I was cheating my patients if I didn't keep up on the latest research and information available; if I didn't critically evaluate and treat in a way that was based in current scientific theory and methods. Does it take a PhD or DPT or other post-graduate degree to do that? No, but it's a start. Sarah
The question for me, and for most, I think isn't if the DPT is a good choice to make for an individual but if that choice should be imposed.
Should it become the entry-level degree for PT's? That is my concern, and it is less a concern than an observation that it will force changes on the profession that many won't like. There have been comparisons to Chiropractors, Podiatrists, etc. but the situations aren't similar. Chiropractors have largely held a monopoly on what they do, Podiatrists don't have many practitioners that overlap what they do, PT's have many direct competitors and some that would like to work their way up to competitors.
More advanced education is great, there are Ph'Ds, Clinical certifications, post-doctoral studies and fellowships, there are more and more educational opportunities open to PT's. But the question that is being asked from others isn't how much education a PT can have but how little they can have and still do the job effectively. The drive for DPT isn't coming from patients, payors or any external entities, it isn't coming in any great extent internally from practicing PT's, it is coming from the schools and the APTA. The only real argument for it's implementation on the profession as a whole, rather than the individual, seems to be the increased status the title of Dr. bestows.
Joined: May 9, 2004
From: West Palm Beach
Randy, I disagree. It is passion that is lacking in our, sorry, my, profession. It is apathy that is killing our field. So if I am passionate about therapy praise me, do not try to bring me down to the apathetitc masses. And no, a PhD is not the highest clinical degree, it is the highest academic degree. And yes, I still want to achieve mine nonetheless. Frankly, there are a lot of people bitching about turf wars and this and that, well I think the transition towards a DPT is what will set our profession aside. If we are Doctors of PT and joe blow on the street is mr.joe bloe with his exercise phys degree and every patient calls their PTs doctor so and so one day, then YES it will move our profession towards a better place in the health care delivery system. and yes, don't hate the player, hate the game. Unfortunately, our country does not understand PT and does not think of us on par that australia, scandanavian couuntries and canada do. And if it did, a DPT would not be necessary. I really have not heard one logical argument from ANYONE that would say why a transition to a Doctoring profession is in any way bad for the profession and how people can get on here and hide behind their insecurities. And jason, do I really shout every time I post? I think I need to golf more and work less... Ben Galin
Joined: November 15, 2003
Maybe you should shout a bit more at the game (not the players...as you said) 'cos every time a US PT has a 'shout' on this bb, other PTs from the countries you mention understand the situation with US physical therapy a little better. And that is important, otherwise we don't get the true picture behind what seems to be whingeing on the surface. It is such a different world; and those less aware will tend to blame only the players, for any number of reasons.
I am certainly understanding it all better every time someone has a shout about the system.
I admire your passion but passion isn't very convincing by itself and it isn't very helpful when it is used to simply shout down opposing views.
You say you haven't heard any logical reasons not to transition to the DPT, I have read several, and only one as to why you should transition, and that is, status. Many find that insufficient. I will present another argument, one that is neutral but should be considered. There is currently a shortage of PT's, as a result health providers are scrambling to get PT's, and when they can't, they look for alternatives. The DPT will create a greater shortage of PT's, simply because more education without greater pay is going to switch some students to other programs. The way that this shortfall is made up now is to recruit foreign therapists, this will no longer be an option.
This isn't necessarily an anti-DPT argument, none of my observations are, but they are things that should be considered instead of simply dismissed as being caused by apathy and ignorance. Not every PT has the same wishes for the profession or their professional life that you do, some see the DPT as a threat to the profession. My wish is to simply see some reflection and argument about the benefits of the DPT before rushing out to make it the standard.
BTW, you stated: IT IS YOUR PROFESSIONAL RESPONSIBILITY TO OBTAIN THE HIGHEST DEGREE OUR PROFESSION OFFERS!!!
This IS the PhD, I don't see how your argument can apply to the DPT but not the PhD. Why not simply require a PhD?
Joined: December 1, 2004
Randy, I don't know what thread you're reading, but I have read many good arguments for the DPT, namely: advanced knowlege, advanced techinical skills, critical thinking and reasoning skills, more autonomy (given a direct access environment), more respect from other practitioners and referral sources, social responsibility and professional duty. Depending on one's professional education (BS or MPT) therapists seeking a DPT (or DScPT) usually want to fill in gaps in their knowlege and skills that continuing ed courses alone won't satisfy (usually not thorough or in-depth enough). They may also want to have a greater understanding and utilization of evidence-based interventions, and/or contribute to research. Therapists pursueing PhDs are generally more interested in teaching and research. Having a shortage of PT's is more of a reflection of the current political state of healthcare and reimbursement than society's image of therapists. It really seems like your grasping at straws here just to keep the debate alive. Your claims are based on conjecture and speculation about the motives of students entering DPT programs. I also don't understand the threat to the profession from other competitors, that the DPT would supposedly allow. Having more educated professionals would set us apart, not make us more vulnerable. Maybe you can expound on this....thanks. Sarah
Joined: April 25, 2004
From: Amherst, WI
I'm going to try to summarize some of the many issues for my own good.
Why the DPT?
1. This is clearly a name change to try to reflect the educational level of the new grads coming out of DPT programs and to have a greater first impression on Joe Public. I'm assuming here that we didn't come up with the degree name first and the program second but I might be wrong about that.
2. Possibly helpful in securing direct access, but doubtful as many states had direct access before the DPT was a gleam in many administrators' eyes.
3. Equal footing with other non-medical doctors.
Why the t-DPT?
1. To get more DPTs.
2. To allow a person organized course work that covers what the new grads are getting these days.
3. Marketing while there aren't too many DPT's to compete with.
4. Sense of duty.
Why not the DPT?
1. Avoiding the unintended consequences of a gamble not won. The gamble being that the DPT is a necessary step to direct access and our job description won't largely change except for the prudent medical screening of a direct access provider. I leave the list of unintended consequences blank since we don't really know what they are. If someone wants to add some speculation, feel free. Randy made some valid points in my opinion.
Why not the t-DPT?
1. Fulfilling their sense of duty in ways other than obtaining a degree.
2. Not feeling a sense of duty.
3. Feel strongly about the "why not DPT" issue.
4. Cost/benefit not in their favor (don't try to fight Maslow here).
I'm not trying to judge any of these, I'm just trying to summarize the issues. Anyone else want to add to any of the lists without casting stones?
Joined: May 11, 2004
For the Why Not?
5. Proof that increased education does lead to improved outcomes when going head to head with BS or MS or comparing to any therapist with board certifications within his/her practice specialty.
6. The BS didn't change complacency... the MS didn't change complacency... proof that the DPT eliminates complacency.
7. Drew always likes to bring up his "moving target" view... well, entry level is entry level and sure having a DPT puts the person in potentially a better position at that target initially... ah, but what happens 7 years later? Where's the proof that a DPT ensures maintaining an adequate level of knowledge as the target continues to move? The argument that those that achieve a DPT have spent years and have lots of passion and will continue to grow is ridiculous because research has indicated that physicians with more years of experience tend to practice below the target. They certainly put in a whole lot more time and effort in their educational process than a PT does.
8. What if the whole thing flops because nothing substantially has changed in the DPT programs and all it really appears is that the PT's are trying to play a political game? A political game based on the degree name and trying to make an impression? Smoke and mirrors is never the best option for altering perceptions unless one is a magician.
9. The Army physical therapists have had a role in being a physician extender and performing primary care since the early 1970's. I could be wrong, but I don't believe that there was a DPT around then... so, is a DPT really necessary to perform direct access? (maybe that is what Jon was alluding to?) Check out the current JOSPT - interesting how we as physical therapists can play a major role in primary care when some of the reimbursement and ego games are eliminated and the goal is efficiency of provision of care.
Why the DPT?
4. The unknown potential benefit of planting the "evidence-based" seed within the brain of the learners.
5. The unknown potential benefit of the what I'd call the "ripple" effect of when a DPT student is on a clinical internship/rotation and begins questioning some of the non-evidence-based procedures occurring. Of course, that is also dependent on a different slew of therapists with potentially a different type of personality profile where there are balls to question instructors.
6. The unknown benefit of maybe a whole group of therapists requiring responsibility and accountability of all of us within this profession and an attitude of not settling for anything suboptimal or substandard.
This is a great discussion, and lots of great points are being brought up. I have to admit that SJ has a point about the moving target of entry-level and "what about 10 years from now?" That's a good point. I'd like to think that it would mean that our profession would develop similar to other clinical doctoring professions in that specialist clinicians are only truly taken seriously if they'd done some kind of fellowship. Perhaps we'd even preclude DPT's from working in speciality areas without being under the mentorship of an experienced clinician --- until a fellowship and passing of a standardized speciality exam. To be sure, a lot of unintended consequences possible to that model --- but it's not even possible until a critical mass of PT's is skilled enough to practice in a direct-access manner that includes the ability to differentiate medical problems from NMS problems, read and order radiographs, and (perhaps, like OD's and DPM's) prescribe some medications specific to our practice scope.
The DPT of the next 10 to 15 years, will not, I don't think, be able to practice in a manner consistent with vision 2020. Those who get entry-level DPT's and transitional DPT's in the forseeable future will be TRAINING the DPT's of the vision 2020. It is, in my opinion, somewhat of a shame that no one tells the t-DPT this until they're just about to graduate --- and even they they usually don't hear the message. What's worse yet, is the bill of goods sold to the new-graduate DPT's who have NO IDEA as to the history of the profession, and have no other experiences or base for opinion other than the "you're the future," and the "experience doesn't count for much if it's 25 years of worthless experience" lines that have been pumped into their brains somewhere along their DPT education.
Why get a DPT now? Because you agree with the vision and want to be a part of shaping the future of physical therapy. I don't believe that there is really any other value at this point, except in very specific areas of the country. Frankly, conservative Charlotte, NC isn't one of those areas.
My question is where was the passion among rank-and-file PT's 10 years ago when the DPT train was just beginning to pull out of the station?
Andrew M. Ball, PT, DPT, Ph.D. Orthopedic Physical Therapy Resident Carolinas Rehabilitation
Joined: September 14, 2002
[QUOTE] Perhaps their passion got crushed after being someone's profit center right out of school. [/QUOTE]This is the norm and until it's gone we will be forever known as an ancillary service. Will the DPT change this? If you say yes then why not grandfather and make all programs DPT= quicker results and furthers the profession at a much stronger pace. I agree with the last 3 posts all together, but why not go the way of every other profession who's trying to move up and grandfather everyone, it has seemed to work for them without the cost of time and money.
Joined: May 9, 2004
From: West Palm Beach
I believe I said it twice now, and I believe it has been said like 10 times total, Randy thew PhD is not the highest clinical degree. It is the hig academic degree, the DsCPT and perhaps the DPT are the highest degrees offered, then obtaining a specialty certification and close on par with a fellowship.
I think that everyone has summed everything up pretty well, and really the only true reason not to get a t-DPT would be just do not have enough cash to do so, even though you may borrow from gov't, but still reasonable enough argument. Ok I think this thread can close for now.