Joined: February 19, 2004
By the way, it may interest you to know that there was a case in Florida 2 years ago in which an insurance company attempted out of the blue to deny payment (it happened to be in a medical office, not a chiro office) for physical therapy services unless performed by a licensed PT. It put quite a scare into us because most DCs here use modalities. The insurance company lost the case, due to the involvement of the medical/osteopathic/chiropractic boards which strenuously objected. I'll tell you this, it's not just DCs doing this kind of thing by a LONG shot, as many medical clinics have non-PTs performing these duties.
The one good thing about the demonstration project is that it will enforce the "incident to" rule for chiro's that currently applies to MD's who bill Medicare for physical therapy procedures. The individual performing the treatment "incident to" the physician or chiro must be either a licensed PT or PTA. This was enacted in January '05 and was to start being enforced in March of '05. Chiroortho: yes it is legal for them to say they do Physical Therapy (see my previous post re: practice acts in Fla) but it is in no doubt misleading to the public. Rick
Greg, by the way, I could live with the term "Physical Medicine", sounds good to me and it doesn't imply that the person doing the treatment is a Physical Therapist, which is what irks me about the way they advertise now. Rick
I don't like ANYONE using the term physicaltherapy/therapist/ or physiotherapy/ physiotherapist except us. So, sounds like the issue isn't just about chiros, it's the whole shebang who are P***ing on our lawn south of the Can/US border! PTs, this means there is even MORE toilet training to be done!
I don't much care for the term Physical Medicine either. Too presumptuous. 'Modalities' or 'physical modalities' is more accurate, doesn't offend any sensibilities, and doesn't presume to be actual medicine, which should only be practiced by medically trained practitioners.
I agree that there is a difference between title and tools. The titles or designations are much more valuable and worth focusing on fighting for than merely the modalities or ways to pop something.
Having said that, here in BC the college of PT will go to the mat to keep anyone but a lisenced PT from doing ultra sound (i.e. aides). I'm not sure there's ever been a case of the college going after a MD or a chiro for trying.. I'll have to ask around. :)
Joined: February 19, 2004
I think up in PA a while ago PTs got together (I'm assuming it was PTs) and set out to restrict DCs from using modalities. Not sure if it was successful or not, but if memory serves, it was. If so, chalk one up for the PTs. I don't agree, but if DCs are going to limit PTs from performing manips in Arkansas, turnabout is fair play.
Diane, I don't know if it's true or not and it certainly may not be, but I seem to recall reading somewhere in years past that DCs coined the term 'physiotherapy'. Has anyone heard that, and if so could it be true? Not that it would matter to me, because it doesn't change my opinion that DCs shouldn't be calling themselves physiotherapists one iota. But if true would be interesting...
Another interesting matter - rehab. PTs are obviously the experts in rehab protocols by training and practice, but as many of you know it's getting more and more popular for DCs to incorporate rehab into their practices for spinal injuries.(moreso than knees, shoulders, etc.). As for me, I send my rehab to a local physiatrist with a fully stocked rehab center with all the bells and whistles, and I have enough to do anyway.
[QUOTE]Diane, I don't know if it's true or not and it certainly may not be, but I seem to recall reading somewhere in years past that DCs coined the term 'physiotherapy'. Has anyone heard that, and if so could it be true? Not that it would matter to me, because it doesn't change my opinion that DCs shouldn't be calling themselves physiotherapists one iota. But if true would be interesting...[/QUOTE]Well, it's not true. What a bizarre idea. Did your chiro school spread that misinformation to you?
Here is a cursory search. Check it out. [URL=http://www.google.ca/search?hl=en&q=history+of+physiotherapy&btnG=Google+Search&meta=]history of physiotherapy[/URL]
Physiotherapy seems to have been one of those need driven professions that cropped up worldwide, on both sides of the first world war, in response to a whole whack of soldiers that needed rehabbing. If there was a country that started the ball rolling and invented the term, it was probably nurses in Britain, in 1894. In Canada, physiotherapy was officially 85 years ago on March the 24th. The main driver to establish the profession as a stand alone profession and not just have non-designated rehabbers in every hospital, was that the rehabbers developed some pride in themselves and decided to get a profile so that they could be entitled to have rank in the armed forces.
[QUOTE]Just curious, What do you think the differences are between the patients we see and those that the chiro's see?[/QUOTE]Patients using chiropractors in North America: who are they, and why are they in chiropractic care?
RAND, 1700 Main Street, P.O. Box 2138, Santa Monica, California 90407-2138, USA. firstname.lastname@example.org.
SUMMARY OF BACKGROUND DATA AND OBJECTIVES: Alternative health care was used by an estimated 42% of the U.S. population in 1997, and chiropractors accounted for 31% of the total estimated number of visits. Despite this high level of use, there is little empirical information about who uses chiropractic care or why. METHODS: The authors surveyed randomly sampled chiropractors (n = 131) at six study sites and systematically sampled chiropractic patients seeking care from participating chiropractors on 1 day (n = 1275). Surveys collected data about the patient's reason for seeking chiropractic care, health status, health attitude and beliefs, and satisfaction. In addition to descriptive statistics, the authors compared data between patients and chiropractors, and between patients and previously published data on health status from other populations, corrected for the clustering of patients within chiropractors. RESULTS: More than 70% of patients specified back and neck problems as their health problem for which they sought chiropractic care. Chiropractic patients had significantly worse health status on all SF-36 scales than an age- and gender-matched general population sample. Compared with medical back pain patients, chiropractic back pain patients had significantly worse mental health (6-8 point decrement). Roland-Morris scores for chiropractic back pain patients were similar to values reported for medical back pain patients. The health attitudes and beliefs of chiropractors and their patients were similar. Patients were very satisfied with their care. CONCLUSION: These data support the theory that patients seek chiropractic care almost exclusively for musculoskeletal symptoms and that chiropractors and their patients share a similar belief system.
PMID: 11805694 [PubMed - indexed for MEDLINE]
The remaining question is to know if the patients have got their mind problems before or after the chiros sessions? :D
Joined: February 19, 2004
[QUOTE]Well, it's not true. What a bizarre idea. Did your chiro school spread that misinformation to you?[/QUOTE]Thank you for setting the record straight for me. I don't recall where I heard it but it was obviously misinformation. For some strange reason, in chiropractic the use of modalitites is frequently referred to as 'physiological therapeutics'. Kind of odd if you ask me. [QUOTE]The remaining question is to know if the patients have got their mind problems before or after the chiros sessions?[/QUOTE]Hey watch it there buddy! I only rarely drive my patients crazy (well, okay, maybe only 50% of the time). :)
Joined: January 31, 2005
January- I would be willing to guess that the results for chronic pain PT patients wouldn't be a lot different. Them seeking care may have more to do with a lack of confidence in the other medical providers they have visited and/or a dissatisfaction with whatever care they have been provided. That doesn't mean the care is the problem, perhaps the patient's expectations of care are the problem. I would think those that frequent any other alternative medicine system would measure out the same - I think there is a baseline level of mistrust of the "established" medical system and a desire to have treatment that corresponds more with their individual philosophy of life. This is what I was getting at when I stated that at the end of the day, I doubt we are competing for the same group of patients. I think there's significant overlap in the groups, but overall I have found that the operational definitions "desires active care" vs "desires passive care" to be useful in describing differences in these groups of patients. While I doubt you will run into too much disagreement with your suggestion (tongue in cheek and joking, I'm sure) that there is a degree of indoctrination and belief sytem buy-in with the profession of chiropractic, I don't think we should be too quick to "paint them all with the same brush". They have many successes to their credit, and to the degree we can learn something from that, we should. Certainly there is more than the indoctrination of a crazy belief system going on there, though that does happen. Just as there is more than hotpacks and leg lifts going on for us, though we can agree that does happen as well.
Others- I think you've made excellent points about where we need to get to as a profession, Diane. I wholeheartedly agree.
And Greg, I appreciate your point of view. I am less interested in telling chiros what they can call their procedures and more interested in telling them what they CAN'T call them. I would think Physical Medicine is a very appropriate term. Certainly that is what the NATA (athletic trainer's assoc in USA) is calling what they do, now that they have had their noses pushed out of shape when they find they can't call what they do Physical Therapy.
I guess our position should be, "As long as you don't call it Physical Therapy, Physiotherapy, or represent as being such or providing such, we have no authority to tell you what to call it."
Physical medicine should work, as should Rehabilitation Services, Rehab Therapy, Sports therapy, etc. I don't think we own, or should own, any of those terms. Hell, call it Physiological Therapeutics if you'd like. Isn't that the purpose of a major chiro journal called JMPT - Journal of Manipulative and Physiological Therapeutics? Just kidding, imagine how much that term costs to put on your sign? Not to mention trusting the spelling skills of those at the local print shop! :)
Greg, I think if you are making an effort to distance yourself from saying or representing that you are practicing physical therapy or providing physical therapy by not using those terms, I find it ridiculous and unfair if anyone would harrass you about some other verbiage. Should you run your signage by the local PT organization for approval before putting it up? :)
It is my recollection that the PA decision you mentioned was to restrict chiros from using the term "Physical Therapy/Physiotherapy" -- don't think any such scope limitation was tried, but not sure. Certainly such attempts to keep you chiros from using Ultrasound or performing procedures that we do is pretty hypocritical of a PT organization. How can we complain on one hand that someone else can't tell us what to do, only to try to do the same to another?
On the question of chiros using more rehab -- I have a good article I wish I could upload about this for discussion, not sure if this is the best thread for it? FEB JMPT had a descriptive study of chiro practice... patient education and exercise (> 80% of time), ice/massage/e-stim/"physical therapy"/US/heat are all in the (>60%) most frequent 'non-adjustive techniques' used. Traction and therapeutic supports are just under 60%....
It seems that non-adjustive techniques are very common for chiros, and may represent the norm rather than the exception. A point for your mixer collegues, Greg, and perhaps an indication of moving away from the straights?
My PT license is in Maryland - the thing the chiros receive is a "certificate in physiotherapy" or some such thing. It's an "out" to be able to use the words we're talking about. Hell, I've had tons of hours of manual and manipulative training, can I get a "certificate in chiropractic". I didn't think so. Gee, that's fair. What a surprise. So we can all see the type of thing that keeps the bad blood boiling... J
[QUOTE]If the literature is so clear on the fact that spinal manipulation is only to be considered in acute injuries and certainly within the first six weeks of such an injury, even then the efficacy is not particularly substantial. One therefore needs to ask the question as to why there is so much manipulation being performed in the community when there is no good scientific data to support such an activity.[/QUOTE]
Joined: March 1, 2003
You are going to hear from Minesota again, here goes: PROHIBITED CONDUCT: No person shall in any manner hold out as a physical therapist or use in connection with the person's name the words or letter Physical Therapist, Physiotherapist, Physical Therapist Technician, Registered Physical Therapist, Licensed Physical Therapist, P.T., P.T.T., R.P.T. or any letters, words, abbreviations, or insignia indicating or implying that the person is a physical therapist without a license as a physical therapist issued under sections 148.65 to 148.78. To do so is a gross misdemeanor. Here, we refer to e-stim, US, etc. as Physical Agent Modalities, or PAMS. I think this started when OTs were getting trained in the use of these modalities. Once again, I am in agreement with Diane. I feel very strongly about this. I look at ads in papers, scan the phone book in every city I visit in MN, and if I see any violations, promptly contact my state chapter.
Joined: January 31, 2005
Jan- Thanks for the link, although the discussion of manipulation does not include some of the most recent trials for both Lx manipulation and neck pain and mob/manip, which contradict some of the statements in that document. The underlying theme [which you stated quite nicely above] does hold true even considering this current evidence, and I agree that this sort of therapy [manipulation] does not have any support when used in a long-term and recurrent pattern. Good point and very relevant to this demonstration project.
Given this information and the current state of knowledge about PTs and DCs, I find this demonstration project [to get back to the title of the thread] to not be a negative for PTs, and even a success here for the DCs could help us as well, as someone else pointed out. Overall, I would think anything that acts to break the current monopoly of health care exists is a good thing for us, if not in the short term, certainly in the long term. Certainly, if DCs are recognized as being able to provide direct access care, I would think PTs [leading the way in manipulative care research and possessing a broader array of other skills relevant to the population] would almost certainly be next. ??
Surely you see the flaw in your logic on this one. To say you do treatments that another profession does, does not make you that profession. And there is no difference between calling yourself a physical therapist or calling what you do physical therapy. Those in your profession who engage in this sort of misleading promotion should be embarrassed regardless what misguided practice language might permit. As pointed out on these posts many times; imagine those in your profession if the shoe was on the other foot, which it easily could be.
I do think it's telling that though many in PT utilize manipulation without for any reason calling it chiropractic, those in your profession don't understand or extend the same professional courtesy.
Joined: March 17, 2005
Jason, The difference is that manipulation is not what defines chiropractic. So having hundreds of hours of manipulation doesnt earn you a "certificate in chiropractic." Chiropractic is a philosophy and belief system (some even say cult). Manipulation is a tool used by chiropractics as treatment. Except they call it adjustments. Physical therapy multi-therapy field that also uses manipulation. I think the Maryland thing is dumb. I had physiotherapy courses in school so I sat for the maryland exam. You have to if want to perform those modalities and get paid. The thing with DCs are that they leave school with training in NMS conditions, basic general medicine, and rehab/pt. The school administration is great at making you think you are just as good as a GP and a PT. Its how they take the focus off chiropractics half truths and pseudoscientific beliefs. The problem is much deeper then a DC saying he does physical therapy. The problem is a DC PERFORMING what he thinks is physical therapy on a patient that needs a physical therapist.
Chirx, [QUOTE]The problem is much deeper then a DC saying he does physical therapy. The problem is a DC PERFORMING what he thinks is physical therapy on a patient that needs a physical therapist.[/QUOTE]I agree, ...and I'd say it goes even deeper than that. 1. I'd say it goes as deep as professional boundary crossing. 2. I'd say it goes as deep as someone claiming to be something they are not in order to assume a fake mantle of respectability. 3. I'd say it goes as deep as false advertising, even if there is some sort of "certificate" involved. Certificates seem to mean very little to chiro schools other than to dish them out to chiro students to reassure them that they are not breaking a law of some sort. (What a scandal, how badly sideways these so-called schools bend vulnerable minds!)
In this case, I'd say that chiros who call themselves PTs or claim to be doing PT or that they took a course and have a certificate to do PT are breaking the Law of Professional Boundaries. There, it has a name now. As Jason has said repeatedly, it's not the 'content' that is important in this case but rather the form or designation. Keep after these guys, like I did with Ken. It's the only way they'll learn. If they are decent people, they'll stop behaving inappropriately in an interdesignate manner. Keep up the good work Tim and Rick and Jason, working on Greg's logic, and way to go Holly! An example to us all.
Joined: March 1, 2003
And it isn't just chiropractors we have to watch for. Not too long ago, a fellow alumni PT reported to the MN APTA some guy advertising as a CPT. (Certified personal trainer). The ad didn't clarify exactly what he was, and those two capital PT things after his name earned him a warning to change his ad. I think back to how involved our faculty was with the APTA and I think it rubbed off on us!
Joined: September 14, 2002
Your post reminds me of Chiroortho ( not picking on chirootho just an example) starting a thread on how to approach treatment on patello femoral dysfunction. Everyone was eager to chip in there 2 cents and I'm sure he recieved great advice, in fact i know he recieved some very good advice. My point is, why didn't he just refer this pt. out to his local chiro friendly PT (perhaps Silvernail) who treats this on a daily basis, the same PT who if a pt. needed an adjustment would refer to him? Once again I'll answer my own question. Because he doesn't care to do that secondary to financial gain and expanding his practice, even though he doesn't advertise physical therapy per say as some do. I certainly cant' blame him or others for trying to get there foot in the door and expanding what they do, but I can blame others for helping in the process.