Wednesday, January 21, 2009

Thanks Chad...

I need to give some much-deserved props to Chad Brinkmann, a physical therapist whose recent letter to the editor in the January 2009 edition of Advance reaffirmed my attitude about the DPT and Vision 2020. While I encourage you to read the full letter for yourself in the magazine, I have to echo some of Brinkman's points and offer them up for discussion or opinion.

  • The APTA has added to the debt load of physical therapy students by pushing the DPT in the absence of any significant difference in pay. After doing some very simple math, students are fleeing to other professions.

  • This potential reduction of qualified individuals in the workforce will inevitably lead to an imbalance between the supply and demand of our services. Fewer therapist treating more patients is not the recipe for quality treatment.

  • The DPT could completely devalue the need for the PTA. Third party payers play "follow-the leader" all too well and will inevitably cease reimbursement for PTA services. Don't think it could happen? Feel free to give me good reasons why they wouldn't. Reductions in the numbers of working PTA's spreads the caseload even further!

I don't believe the DPT is an awful way to go, and sincerely respect my colleagues who have earned the credential. I have more than a few DPT friends who will likely rip me pretty hard for this post. However, it is appearing more and more that the APTA tested the water by jumping in with both feet on Vision 2020. In our obsession with becoming a "doctoring profession" we have lost site of the realities our our practice today.

I rejoined the APTA last year and plan on renewing my membership again and again, but I think it is important for us to join Chad in voicing our opinions about the direction we should be heading. Having a vision is one thing, but I think we developed a case of hyperopia in the process. I join Chad in encouraging the APTA to make Vision 2020 a fluid one in which the goals of our profession in eleven years reflect the realities of today.

Good on'ya Chad...


  1. I'll have to rip you a little Rod.
    1. The PT students that graduated 3 years before I did from the same University paid for 3 years of education to get a masters - I received my clinical doctorate. Point: I bet most masters programs where already basically at a doctoral level in terms of credits. Seems my money was better rewarded.

    2. Where is the data that "students are fleeing to other professions"? Again a MPT over 3 years or a DPT over 3 years. If they are leaving, I'd be more inclined to say it's d/t the time. And I want professional and not "best money for shortest time effort" in our profession anyways.

    3. PTA devalued? Well, maybe will agree with you there. IMO, it's not insurance or DPT doing it though. It's the academic elite pushing the "1-on-1 with PT only" philosophy for any treatment causing this. Damn, does it really take 7 years of school to be qualified and paid for an US? come on!

    4. If there is a reduction in PT's, then wouldn't that drive up the importance of PTA's? Isn't that how PTA's came to existence in the first place?

    I think Vision 2020 has it's place. We just need to translate for the public.
    - Doctoral profession: We are not technicians. We are comparable to other "clinical doctorate" professions.

    - Practicioners of choice: Save your money and skip PCP's with little to no MSK knowledge, MRI, and medications; and get the best conservative care by going to a PT. Now blackberry thumb and backpack education isn't going to convince the public of this. So, until APTA does a better job, we as individual practitioners need to toot our horn when we can to the public.

    - Autonomous practice: We need to not only be able to make clinical decisions based on pt need (vs state practice act - manipulation - insurance demands, crazy talk by elitist academics) and, more importantly, be willing to self police (preferably w/o the threat of being sued to stop that self policing).

    Thanks Rod...

    Jason Haris

  2. I am not seeing why you would think having DPTs would devalue the need for PTAs? If anything, I would think the expense and shorter supply of DPTs might create a demand for more PTAs as health care cost rise and health care establishments seek ways to cut costs. My youngest is still in college, so in addition to my out patient setting, I still work registry on weekends in a local hospital on weekends for extra money. I can see that they might want a PT to do evals, and PTAs pick up on all follow up visits, because, patients are only in the hospital a short time anymore (3-4 days for joint replacement versus 10 days or more when I started working in '79' for example), so most of what we do in-patient is getting people up, getting them moving, giving them a few light exercises. Sure, you have to have some good knowledge on what to look out for, but the PTA, and heck, even the good techs, could easily handle a lot of what is done in inpatient work. The PTAs and techs trained on the job with experience have more savvy then a lot of new grad PTs on discharge plans, and how to handle folks. It may be that, in the future, they may come up with "mobility aides" for run-of-the- mill stuff to save themselves the expense of the heavier duty PT salaries, and just have a few PTs for more involved cases or patient groups for inpatient.
    And in post surgery out patient ortho, where most rehab follows a protocol...PTAs may just take over that domain, because a person with a doctorate, unless they are doing research, may find it rote to follow a MDs protocols all day long. One PT may end up doing evals all day long to feed the PTA's schedules, and never get to treat patients themselves! I imagine that already happens at some places.

  3. Jason and Barb. Thanks for your comments. The main thrust of my point in echoing Chad's comments was to say Vision 2020 puts the cart before the horse. I believe we should become a first-line provider for movement disorders and agree with many of the points both you make.

    I think we should have devoted our efforts toward gaining traction on direct access prior to establishing the DPT, and we seem to have done this a bit backwards. The DPT, as it is currently constituted, is not considered any more "relevant" than other PT credentials. If it were attached to preexisting direct access laws, then I believe the value and demand for DPT would increase sharply.

    I think all this will happen, but think we have slowed the momentum by not putting more of our eggs in the direct access basket. I'm always prepared to be wrong. Again I appreciate the comments.

  4. I fully agree with your DPT stand. I also agree that our DPT does not make us more valuable to the referral communities we rely on. I also feel that after working with new graduates, the knowledge base they begin their carreers with is not laden with improved clinical knowledge rather with the research of edidence based materials which are ever changing the day they enter their "real world" occupations. Many good treatment strategies are ommited due to the fear of not haveing enough current evidence in those techniques.
    I also feel that our DPT students and graduates lack in exercise prescription skills and I always encourage new graduates to obtain their CSCS or PES credentials if they wish to be competetive in today's orthopedic realm.
    As far as salaries relative to our DPT degree level--I foresee similar scenarios as European countries have experienced for a few decades. Countries filled with Doctorate level workers who can't find the salary they expect for their education level due to the plethora of applicants with the same credential.
    Monique Haviland PT, MS, CSCS, PES, OEC, CPI
    Provider for the USSA (US ski and snowboard assocation) and owner of Bodywise Physical Therapy in Lake Tahoe NV (775-783-7606)

  5. Jess Brown, PT, MS, OCSFebruary 2, 2009 at 1:33 PM


    Check out what has going on in Virginia - the state made changes to its direct access legistlation relatively recently which give the DPT a bit more weight. Essentially non-DPT practitioners have to obtain a t-DPT or show evidence of medical screening coursework if they want to obtain direct access certification.
    See below:

    I have no idea how many BS and MS PTs have ataully obtained the certification (or have chosed to obtain the t-DPT, but it is sort a unique stance for state legislators to take.