I am writing to discuss a hypothetical answer to the DPT controversy and allow all PT's to decide what fits them best. There is a clear, palpable divide in the profession regarding the utility of the DPT, and this I feel quite strongly is holding us back from advancing forward.
I believe that there must be a alliance of those wishing to promote the DPT. Practicing as a "first line" provider and possessing the skill set inherent to excel in this role should provide DPT's with salary, professional recognition and advancement commensurate with those at the forefront of the profession.
For those PT's who wish not to pursue the DPT, I do believe that it is certainly a choice but one must then accept limited growth potential in all aforementioned areas. Please let me clarifiy that a DPT versus a non-DPT without strict benchmarking does not mean that a DPT is inherently better. The opportunity will always be open to those who choose to move forward!
What is clear to me is that the value of the DPT, is grossly underestimated. I obtained my t-DPT after 13 years of experience and have experienced tremendous professional growth. With regard to critical thinking, new evaluative models and a full appreciation and mastery of using EBP, there is already a higher level of competence that a DPT is offering at this time and growing.
I will admit to frustration in our ability to grow as a profession as I beleive we are able to. Those disparaging of the DPT, seem "uncomfortable" with the role and yet do not acknowledge it, but instead provide little constructive criticism..just rants about cost, lack of the need for the DPT etc.. In short, a lack of confidence and belief in themselves it appears.
In contrast, those embracing the DPT, which are the leaders of our profession and the many who do espouse the benefits speak with great excitement and limitless growth potential.
Each side should move ahead as they wish, however I for one, do not want to be held back in my growth by being linked to a large segment of colleagues that do not feel the same passion, vision, and commitment to excellence!
If you wish to be a part of this alliance, please indicate it, if you wish to respond. As a large united body, we can pool our experience, resources and excitement and stop the visionary overtures and become the next generation of PT's, the primary provider of Musculo-Skeletal Rehabilitation
Joined: February 8, 2009
As a pre-PT but will say pre-DPT because this is the new reality of this profession moves into the future, I will say that I'm quite concerned about this divide among PTs. I have researched and understand both sides of the argument. There are both positive and negative aspects to the DPT. Right now the balance seems to weigh more toward the negative due to its infancy. Right now there seems to be little benefit to the DPT compared to the BsPTs and MsPTs. I think overall this transition does need to be embraced along with the changes that seem to be inevitable in the years ahead.
I believe that this country is approaching a critical point in its history. There is an inherent problem looming in the balance. Very soon this country will be challenged to provide care to very large baby-boom generation that will last for decades. With this demand for services, there is a lack of funding. This is a very important concept that seems like it is barely talked about. With this lack of funding, it seems there will have to be a necessary change in practice. Maybe this change will result in less reimbursement for service rendered. Maybe the change will also result in a change in how the services are rendered.
I think that healthcare providers will all be challenged in the near future to provide what works and a reduced cost. It looks like the healthcare system is headed into unchartered terriortory. Maybe the DPT will provide means for physical therapy to emerge as the primary neuromusculoskeletal provider. It does look as if it could provide the infrastructure for change. It won't change on its own though. If PTs don't embrace the change then neither will the public or policy makers. I think that is a pretty clear, accurate assertion.
Joined: May 11, 2004
Shoot, I have no lack of confidence in myself. I refuse to spend a ton of money to say I have a DPT. Nothing changes with a DPT - nothing. State practice acts are as they are and it takes years to have them changed because of the politics involved and the fear of those against physical therapists having a real role in being experts fighting the progression. I just received an email from Justin Moore about Alabama needing help to become direct access... the data needed and the information needed to help the situation has nothing at all to do about education. It has to do more with money and that physical therapists won't reduce the cash flow for orthopaedic surgeons... or how orthopaedic surgeons appreciate physical therapists having direct access. Our reimbursement continues to decline and it isn't a financially secure decision to spend the thousands of dollars to have no return on the investment. Some decisions need to be made from a business perspective and not emotions or the "right" thing.
Our profession has gone from BS to MS to DPT - that's great, but to use fear tactics to convince someone a DPT is needed is a crappy argument. No one in our profession will lose their license by not acquiring a DPT.
Believe it or not, with a lot of work and commitment, one can stay knowledgeable in anything one wants without the actual letters behind the name and THAT is what we really need - people with passion and commitment. Passion and commitment are what will create change - not a higher level of education.
I experience professional growth every day based on the choices I make... some people may need a formalized program but it isn't necessary. I have passion, commitment and always grow, but I'm sorry, I do not believe a DPT is necessary or required for physical therapists to be viewed as the musculoskeletal experts. It is actually a turn off to hear that those with a DPT will lead... anyone can be a leader, anyone.
(edit... Justin Elliott sent the email... sorry, I get the Justin names mixed up)
< Message edited by SJBird55 -- April 15, 2010 9:25:10 PM >
I will second what SJ posted above. I think the failing comes fromthe academic institutions in that the "DPT" professionals do not have up to date research and evidence information. The academic programs are still teaching information that is outdated and behind the times of current information...most notably in neuroscience and what actually takes place in the treatment interventions. Manual therapy is not about changing positions of joint or lengthening of connective tissue, it is about stimulation of the PNS and CNS to decrease a level of threat and ultimately start a cascade of events the changes the experience of pain, motor protection/output and function. I think the DPT was put ahead of the need for more research into the why and what and how of PT interventions that is greatly lacking from an evidence based perspective.
Now there may be some institutions that are ahead of others, but from what I have seen, the vast majority are out dated with the fundamental information they are providing to students that are paying for an education that is inadequate.
I heard a big push for the DPT was that most PT program's Master's degree was one of the more stringent Master's degrees out there. So, it was thought with a little more education it might as well be a Doctorate. That makes sense to me.
MT vs. DPT... I have a DPT and I don't see a difference. A few extra courses isn't going to make or break the professional. Its down to the individual, not the degree.
If our Master's were already 95% or whatever the work of a Doctorate degree, then switch to the stinking Doctorage degree makes sense. The little bit of education though is NOT worth the insane tuition bump being asked for.
I think the DPT is good for the profession, but I think the PT programs themselves are the ones laughing all the way to the bank, because now they can jack up their tuitions because they offer the shinny new degree. They are benefiting the most from it by far IMO.
From a reality standpoint, this is what I see happening to our profession with the DPT. 1. Decrease in number of PT students based on tuition costs alone (this is the real reason schools want the DPT. ='s more $ for them) 2. New grads expecting unrealistic salary ranges b/c they have a DPT and their PT instructors filled them full of BS 3. No increase in reimbursement if treatment is provided by a DPT 4. Little to NO action in non direct access states to establish PT's as some form of front line providers even though current estimates are a shortage of almost 45,000 GP/FP Dr's within the next decade. 5. Complete lack of professional association participation as seen with the DC and MD/DO professions. How far is your state's $50K PT PAC money going to go vs. millions spent in legislative lobbying efforts by AMA and the likes? Just aks SC right now. 6. Recruiting nightmare due to #1 and #2 7. Continuation of apathetic and habitual practices that do not advance our profession
Joined: February 8, 2009
Based upon what is written, the DPT has more negative effects than positive. Overpriced education that's not even adjusting their curriculum to one that is based on EBP in a political world that seems to be dominated by DCs and Physicians. Am I correct to state that the DCs as a whole have a more effective lobbyist group than PTs? This whole process has been very discouraging. It does seem like I'm digging a deep dark hole filled with student loan debt only to find when I'd graduate with my PT degree I'll barely be able to pay these loans back. I don't see how this is good for the profession as a whole. Are there any signs at all that reimbursment for PT services could increase? All I see is a decrease in reimbursment. How is this sustainable if the costs in both money and years to become a PT keep increasing?
Joined: December 22, 2007
I think you have already answered your own question. It isn't sustainable. Thankfully misery loves company and other professions are faced with the same issues. The question is what will we do to increase our sustainability? The DPT appears to be a great idea until you look more deeply into the issues currently facing the profession.
There are ways to stay ahead in the game of managed care. Facilities that I assist have actually increased their net revenue per visit an average of $3 per visit vs. our 2009 final numbers, with several clinics at $10+. Creative billing and coding following the guidelines and defintions put forth by the AMA and by the managed care industry itself in a legal and ethical manner can have a (+) effect. $3 may not sound like much but if you're a clinic that sees 1000 per month volume, you just made an additional $36,000 annually and that will keep you running a few more years. We are traditionally apathetic and habitual billers and if you change that mentality (Does the radiologist charge you less if it only takes 30 seconds to read your normal x-ray?......NO!) you can make a difference. The DPT started as a noble cause but the (-) impact it now being felt. The PT profession will survive but probably not in the same form as our glory years prior to 1998.
I appreciate the posted responses to my initial inquiry and would like to clarify my point somewhat. I personally do not wish to remain an ancillary provider instead of a primary provider and the DPT route is the best one available. If you have not actually walked the walk, how can you scrutinize the value of the content? As a seasoned Pt, I can whole-heartedly say that it significantly changed my approach to practice in a very profound and highly productive way. Does this mean that I feel that I am better than any of you clinically? Absolutely not!
I believe that the knowledge that we possess, uniquely positions us to step forward as the experts in the area of rehabilitative medicine and that we need to brand ourselves (the APTA is attempting this right now) and market our services and dramatically increase our visibility to the public and fully explore our full potential. To hold the title of DPT, may seem ridiculous to some, but the title connotes a dramatic shift in our direction of growth, communicates our confidence as primary providers and our "stepping up" to our rightful place in the world of rehabilitative medicine.
In my situation, I graduated with my MPT in 2006. The class that graduated in 2007 did so with a DPT after taking more classes and paying more money. Is it feasible to think that a few classes and a few thousand dollars trumps the year I spent in the clinic? I don't think so.
I've gotten myself "in trouble" on Twitter debating this topic (sorta--it was about DPT practitioners calling themselves Doctor--I don't like it. I think it sends a mixed message to the general public when in essence, the public has no concrete basis of what we as professionals do).
Joined: May 11, 2004
Ken, those that seemed to be disagreeing with you on twitter are involved in transitional DPT programs... And... don't kid yourself completely... your hours and years in a clinic don't mean squat. Years of experience does not equate to "expert" or expertise in anything. What matters is how you grow, learn, self-reflect and continue to be curious and continue to try to do better. Monitoring your quality and changing/improving your quality is what matters.
Clinicians should not be debating the topic of the additional education that he or she gets in a DPT (and yes, much of it can be gained via continuing education, but not in a focused and integrated way) or a post-doctoral clinical residency, or a post-residency clinical fellowship, etc . . . . versus the wisdom of year(s) of clinical experience. If you are having that internal debate, you're not the clinician that you think you are. Your patients deserve BOTH the highest academic achievements, the most continuing education, and the most years of experience that you can bring to the table in solving their human movement dysfunction.
Andrew M. Ball, PT, DPT, PhD, MBA (and 15 years clinical experience, about to start a post-doctoral clinical residency in orthopedic physical therapy)
Joined: May 11, 2004
What patients want are clinicians who will help them get back to life in the quickest amount of time AND to have whatever problem eliminated. If a clinician can do that, the patient is completely satisfied. Based on published literature, what expert physical therapists had in common most definitely wasn't their level of education or their years of experience.
Joined: December 22, 2007
Agree with Andrew. The DPT is the new standard so there is really no point in debating its merits. Although I will be honest that I jump off at the tDPT. I'm not sure there is a poorer return on investment than that. If you are going to take the time - opt for the residency/board certification. Either that or go for the real doctorate - a terminal one (Ph.D./Sc.D./D.Sc.) which actually broaden's your opportunity and knowledge base.
I heard a really good talk one time on the differences between a Doctor of Physical Therapy and a doctorate (i.e. terminal degree) in physical therapy. It's worth exploring that distinction before making your decision.
< Message edited by TexasOrtho -- December 11, 2010 9:05:36 PM >
Just playing the devil's advocate here: Why would a "new standard" NOT get discussed and debated?!?
Is that not the best way to have a constant evaluation of the merits and misses of a process? Blanket acceptance seems a little out of your usual open-eyed look at most any subject, Rod.
Would it not be interesting to see what exactly the DPT has done for the patients - in real life? And what it has delivered in the political realm for the profession? And for direct access? And for the insurance coverage for physiotherapy? And for the growth of science in our profession - or not?
Are these not the questions that can help drive improvement in the actual curriculi of that very DPT? And evaluate whether it has been just a natural development of ANY education, rather than a specific and well-thought out step towards a better profession? (Think about teaching, nursing, medicine, physio years and years ago - all going from virtual apprenticeships to post-grad degrees in over just one century).
About the "unite versus divide" - I don't think it'll do either in a big way. For some individuals maybe, but not for the whole of the profession.