Do doctors of physical therapy need to call themselves 'Doctor'?

I wonder how the rest of the profession should view my physical therapist colleague who, having earned her Doctor of Physical Therapy (DPT) degree from a prestigious university, won't call herself doctor.

Not only will she not call herself doctor in the clinic, she asks people who DO call her doctor NOT to do so again.

I feel disappointed in her, not just because of her behavior, but for the reason she gives people, such as the front desk clerks in the physical therapy clinic, the equipment vendors and the patients when they initially call her doctor.

"I'm not a medical doctor, like some of the physicians I work with, and I don't feel confident that my expertise compares to their expertise - even though we each claim separate bodies of knowledge."

She is still young - only about four years out of her DPT degree. She works in a setting where she is in close contact with physicians - a physician-owned physical therapy clinic.

This physician-owned practice claims they provide collaborative care.  They emphasize the close communication among the physicians and the physical therapists.  From my colleague's behavior however, I suspect her workplace has impaired the development of her professional autonomy.  The American Physical Therapy Association's Vision 2020 Statement states:

Physical Therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, activity limitations, participation restrictions, and environmental barriers related to movement, function, and health.

Do doctors of physical therapy need to call themselves Doctor? 

I believe physical therapists should call themselves doctor if they have earned the right.  Please note, I have not earned the right to call myself Doctor.  Many other physical therapists have learned the specialized knowledge and skills to achieve great results without earning the DPT credential.  However, according to Randall Collins' 1979 book The Credentialed Society:

"In a credential society, such certifications may become more important than actual skills or abilities.  

In some cases, employers may require formal credentials, such as an advanced academic degree, for a job that can be done perfectly well by applying skills acquired through experience or informal study.  

This type of credentialism is common in white-collar jobs, which require workers to have difficult-to-measure skills such as critical thinking.  

Rather than measure or evaluate those skills directly, employers assume that anyone able to earn a credential must possess those skills."

'Skilled physical therapy' is a phrase that can provoke endless discussions among bloggers and commenters. There is a link between greater education and better results for patients.  More importantly, the DPT credential is, I think, an important step in the social legitimization of the physical therapist skill set. Physical therapists need to use the term Doctor to fully capture their investment in the time and money, not to mention for the benefit of the physical therapy profession as a whole.

Physical therapists do have one of those hard-to-measure skill set noted by Collins. So do physicians.  In hospitals, the physician credential is NOT optional.  The culture of medicine does not allow physicians to communicate with patients using their first names.

What go me thinking about my DPT colleague is an article called The Power of Professionalism in the September 2013 PT in Motion magazine (featured at APTA.org) whose print version arrived a couple weeks ago.  In the article, new graduate DPT Jean Miles says...

"What professionalism boils down to for me is being the strongest advocate for your patient that you possibly can be... Not that you have to be a DPT to be a strong patient advocate but I personally gained so much confidence..."

American society will need doctor-level professionals to manage the burgeoning rolls of newly-insured patients who have just become eligible for health insurance coverage on October 1st, 2013 under ObamaCare.

America's 800,000 physicians will face an increase in demand for their services - that, in some cases, they may be unable to deliver.

I first wrote about this in  Can Physical Therapists Replace Physicians as Primary Care Providers in Hospitals? in a November 2011 blogpost on PhysicalTherapyDiagnosis.com.  This post got a good response and a lot of traffic.

Every day, I read about non-physician providers stepping up to fill the demand in America for appropriate, high-quality services the patients need.  Cost and risk are both considered when society shifts tasks away from what physicians have traditionally done.  This article describes Physician Assistants providing basic care to rural and underserved communities.

Physical therapists can fill those roles for patients with chronic pain, sports injuries and other, low-risk conditions.  But first, society needs to understand and accept that the profession of physical therapists is a doctoring profession.  We should call ourselves 'Doctor'.

The American Physical Therapy Association (APTA) maintains a professionalism webpage which contains the core documents defining and describing professionalism in physical therapy.

I wonder if commenters to this blog can help me? 

What can I say to my colleague to encourage her to call herself Doctor?  How can I help her gain confidence so her patients and the physicians she works with can call her Doctor, too?

Nurse Practitioners Seek More Authority in Florida

Ryan Grella, a physical therapist from the Tampa Bay area has brought to light this new article in the Tampa Bay Times: Nurse Practitioners Seek More Authority in Florida.

Ryan and I and several of our friends, peers and professional colleagues have discussions on Direct Access to Physical Therapy all the time. Here is Ryan's Letter to the Editor of the Tampa Bay Times:

"The nurse practitioner story in the Tampa Bay Times sheds further light on Florida’s antiquated healthcare laws, which are driven in part by highly funded medical organizations as well as physician lawmakers who have inherent conflicts of interest.  

The citizens of Florida deserve access to high quality evidence-based healthcare devoid of unnecessary rules and regulations.  

Presently anyone in this state can receive care from a speech therapist, occupational therapist, massage therapist, or personal trainer without physician oversight. Yet, state licensed doctors of physical therapy must refer their patients to a physician after 21 days.  

This provision exists under the veil of public safety despite overwhelming evidence of physical therapist competence and direct savings to the patient. The Florida Medical Association (FMA) is adamantly opposed to any legislation that would remove the 21-day provision.  

Should we be surprised?Apparently not.  You wouldn't expect the FMA to object to anything that changes the status quo.  

Physicians are now competitors for the patient’s valuable healthcare dollars. At some point however, nurses and physical therapists must ask the FMA and lawmakers, is it about the patient, or is it about the dollar?"
 

Ryan Grella, Physical Therapist

British Physical Therapists Gain Prescribing Rights

"This is a truly historic day..."

The 51,000 British physical therapists (physiotherapists) can now become trained to independently prescribe medications to their patients.

They are the world's first physical therapists to be granted drug prescribing rights within their health care systems without needing a physician to sign the prescription.

"Once suitably trained, physiotherapists in the United Kingdom will be the first in the world to be able to independently prescribe medicines where clinically appropriate,such as painkillers and anti-inflammatories", said Earl Howe, the British Department of Health’s Under Secretary for Quality.

The decision would reduce a layer of bureaucracy and an unnecessary burden on doctors who have, until now, had to counter-sign prescriptions drawn up by physiotherapists who have been "supplementary prescribers" since 2006.

The response from the British medical profession has been overwhelmingly positive.

British physical therapists fought for 10 years to gain independent prescription rights.

I would like to see the same changes take place in the United States of America, however, I am doubtful that the American medical establishment would be as supportive of physical therapists as the British physicians seem to be.

Evidence that increased competition (possibly from physical therapists) drives down prices and increases quality of American healthcare would only be seen as reducing physician income.

Fear of lower physician salaries would draw political opposition from the American Medical Association.

Presumably, Great Britain's "administered price system" (similar to Medicare) is what allows physicians to support physical therapist prescription rights.

What do you think?

Physical Therapists Cannot Opt-Out of Medicare

From First Coast Service Options e-news (June 18th, 2012): Private contracts between beneficiaries and physicians or practitioners.

Title 42, Part 405 of the Code of Federal Regulations outlines the guidelines and requirements for physicians and/or non-physician practitioners who wish to enter into private contracts (opt out).

These regulations permit a physician or practitioner to opt out of Medicare and enter into private contracts with Medicare beneficiaries, if specific requirements of these instructions are met.

Definition of physician or practitioner
For purposes of this provision, the term “physician” is limited to doctors of medicine and doctors of osteopathy who are legally authorized to practice medicine and surgery by the state in which such function or action is performed; no other physicians may opt out.

Also, for purposes of this provision, the term “practitioner” means any of the following to the extent that they are legally authorized to practice by the State and otherwise meet Medicare requirements:

• Physician assistant
• Nurse practitioner
• Clinical nurse specialist
• Certified registered nurse anesthetist
• Certified nurse midwife
• Clinical psychologist
• Clinical social worker
• Registered dietitian
• Nutrition professional

The opt-out law does not define “physician” to include chiropractors; therefore, they may not opt out of Medicare and provide services under private contract.

Physical therapists in independent practice and occupational therapists in independent practice cannot opt out because they are not within the opt-out law’s definition of either a “physician” or “practitioner.”

Fear Avoidance Beliefs Are a Learned Behavior

• "You shouldn't bend you back when you lift things".
• "Don't work too hard".
• "Don't go back to the gym until I tell you its safe".
• And (drum roll please), the most egregious commission of all - "Consult with your physician BEFORE you begin an exercise program".

Are conventional physical therapists in danger of creating what MovNat founder Ewan Corwin calls "zoo humans"?

Watch this 1:32 video and leave a comment. Its pretty impressive.

Maybe physical therapists and their patients could learn from two-year old Steven in the video below some tips for confronting their movement limitations.