"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Friday, May 11, 2012

Direct Access to Physical Therapists Can Reduce the Physician Shortage

Think physical therapists have it rough because our patients don't have direct access to our services?

State laws preventing direct access to physical therapist services still exist in four states:
  • Alabama
  • Indiana
  • Mississippi and
  • Oklahoma 
But, this recent article in The Atlantic by John Rowe, MD and professor at Columbia University exposes the plight of nurses and the political hypocrisy of physician organizations.
"...nurses are only permitted to practice independently to the full extent of their training and competence in 16 states and the District of Columbia. The remaining states (34) impose regulatory barriers that limit their scope of practice."
A 2010 Institute of Medicine (IOM) report on Advanced Registered Nurse Practicioners (ARNP) found...

"...the report concluded that properly trained APRNs can independently provide care primary care services as effectively as physicians."
But, according to Dr. Rowe, attempts by nurses to expand their scope of practice are blocked by physician organizations at the state level, such as...
  • The American Medical Association
  • The American Osteopathic Association
  • The American Academy of Pediatrics
  • The American Academy of Family Physicians
Social and cost pressures are growing to allow nurses greater decision-making authority. Physical therapists should also participate in this "flattening of the medical hierarchy".

But, physical therapists need to first practice more like primary care providers by providing basic screening care, like measuring blood pressure, according to this new study by Diane Jette and Dianne Jewell in the April Physical Therapy Journal.

Listen to PTTalker interview Dr. Jette here.

The problem is that physical therapists don't see themselves replacing physicians as primary care providers According to Drs. Jette and Jewell...
"...physical therapists may not see themselves as providers of primary or secondary prevention services. Patient management strategies associated with these types of services also may be perceived as relatively unimportant or burdensome."
Further, physicians cannot and perhaps should not be asked to provide all of these services.

Zeke Emanuel, MD, PhD argues in the May JAMA that we should "Shorten Medical Training by 30%":
"Years of training have been added (to the physicians' curriculum) without evidence that they enhance clinical skills or the quality of care.  
This waste adds to the financial burden of young physicians and increases health care costs.  
The average length of medical training could be reduced by about 30% without compromising physician competence or quality of care."
There will be no physician shortage in America - not if physical therapists can step up.

And I think we can.


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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

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Consistent with the American Physical Therapy Association Vision Statement for Physical Therapy 2020, the American Physical Therapy Association supports exclusive physical therapist ownership and operation of physical therapy services.