What's all the fuss about?

Help me, our EIM inbox is full.  We have been deluged with news, frustrated PT's, and questions regarding University of St. Augustine's entry into a transitional type of physical therapy program for Chiro's. Apparently, the program will allow Chiro's to continue working while taking courses and eventual graduation whereby they can sit for and obtain PT licensure.

Perhaps I am missing something but under the assumption of accreditation of the program, what is the problem?  I can only assume that Dr. Paris, an incredibly successful entrepeneur and the owner of the largest and only proprietary physical therapy program in the US has done his homework.  This would suggest that there is a market for such a program in part based on the fact that Chiro's are probably frustrated with their own profession.  If there is no market for this type of program, then it will not survive.

In my career, I have seen PTA's, ATC's, and PA's desire to return to school and obtain a PT degree.  I don't find it suprising at all that Chiro's want to do the same and a flexible and "modern day" approach (again with accreditation as the proviso) makes great sense to me.

Thoughts?

Larry

Comments

[Britt Smith]

I agree Stanley Paris does his home work and there must be a market out there for this program. And I Agree on the score of frustration within the chiropractic community. The best case scenario would be some of the best of the chiropractic profession would take advantage of the opportunity.
I'd think we can predict the outcome of this program on the two professions. The AMA in California tried to eliminate the osteopaths in the late 1950's and early 1960's by offering a 'grandfather' certificate to DOs who payed a nominal fee, signed a paper and dropped the DO from their names. There was some other contingency on their use of MD, but I don't remember. At the same time the AMA acquired and operated a DO medical school in the LA area (I believe it became Cal State Riverside...one of the medical schools in LA). The upshot of the moves was to give full legitimacy to DOs (much to the AMA's chagrine). The AMA tacitly acknowledged DOs as an equivalent degree.
Paris is not doing this here. He is inviting the DCs to enter the school under a format that is fast becoming, for good or bad, the university of the 21st century. He makes clear the DC have to have a bachelors degree (not required for admission to chiropractic school and only required for licensure in 5 states in the US) and they have to have an acceptible GRE, again not a requirement for chiropractic school.
Ah, Stanley Paris is always a provocateur and visionary, not mutually exclusive qualities. We will see where this goes.
Britt

[Britt Smith]

Sorry...I meant to say 'I don't think we can predict...'

Britt

[Louie Puentedura]

What's all the fuss about?

Most physical therapists have probably learned about this issue through the PTManager listserve when Andrew Ball, PT, DPT, PhD posted a copy of an email that his chiropractor friend had received from Stanley Paris about the proposed DPT program for chiropractors. The title of the post was "St. Augustine to explore offering t-DPT to DC's?".

At first blush, the thought of chiropractors being considered for acceptance into a transitional DPT program must seem outrageous to all physical therapists. The whole idea of a transitional DPT program is for a physical therapist with either their Bachelors or Masters in PT to 'transition' to the clinical doctorate by taking whatever extra credits may be deemed necessary to equate with the entry-level DPT. The thought that a chiropractor's educational transcripts can somehow be equated with that of a physical therapist must seem 'out there' to most of us. So, the thought of them signing up in Boca Raton for anywhere between 6 to 20 credit hours in order to earn their t-DPT quite naturally inspired outrage amongst many of the subscribers to the PTManager listserve. There has actually been quite a robust discussion on the topic since it first posted a couple of days ago.

Now that we know it is not a 'transitional' DPT at all, but rather, a 12 semester, entry-level DPT program that will require chiropractors to complete clinical placements (internships) and all the coursework one would expect from a basic entry-level DPT program, the idea isn't as disconcerting. If a practicing chiropractor is willing to invest the time and energy to complete a full DPT program, then that's terrific. I'm sure we would all wish them well.

But if Stanley Paris is going to help chiropractors cut corners and grant exemptions or credit for 'advanced standing' or 'transfer credits' then we should rightly voice our objections in the interests of patient safety.

Here is Andrew's original post on PTManager:

PTManager listserv:

A chiropractor friend of mine sent me something of a distressing e- mail. While I can see a possible benefit of creating a program of this type for the right individual, it is somewhat alarming to see that, if this is true, Dr. Paris may be reaching out to DC's at the expense of his own profession. Many, if not most, DC's see PT's as subordinate paraprofessionals and the DPT as an "online certificate." It may be a good thing. It may build a bridge between our professions in a way that has previously not existed. On the other hand, it may serve to allow DC's to use a t-DPT as a billing tool, or to simply earn it so as to proclaim the "rigor" of their degree and the infant education of ours (not that any of us would agree). Finally, the fact that DC's so misunderstand the clinical doctoring profession of physical therapy may lead to a high application and acceptance rate, and an VERY high attrition rate (read DC's not able to meet the demands of the program).

In any event, I find it somewhat distressing that Dr. Paris, known to be a fierce and well respected leader in our profession, may be considering selling out the new, young crop of DPT's and t-DPT's before they've had an opportunity to make their mark and change, for the better, the future of the profession. I feel that we as physical therapists are owed some kind of explaination --- or are at least owed the same respect offered to those in other professions.

This is the e-mail I received. Dr. Paris asks for the word to be spread. I just don't think he expected for it to be spread within his own profession before getting a little further along with his new friends. I say that discussion and debate WITHIN our profession is healthy, and necessary BEFORE CAPTE weighs in. Please read, and respond, to the notes below:

Colleagues,

We have now set the date for the meeting where the University of St.
Augustine will host chiropractors interested in our plans to make a DPT degree available through a combination of online learning with weekend hands on seminars.

The date is Saturday 6th in St. Augustine and at the University.
There will be a reception at my home the night before at probably 6:00 pm.

An agenda will be sent to you in advance as well as possibly some additional information. The day will no doubt begin with a questionnaire (no name required) and then launch into a description of the University and the DPT program

We will certainly cover such items as "advanced standing, transfer credit etc." I shall be in attendance along with the director of the DPT program at the campus here in St.Augustine and the director of the program in Boca Raton where the seminars are held. The director of our online programming will also be present along with one or two others. We will schedule to meet till I suspect mid afternoon. There will be plenty of time for questions and discussion.

At this point I would ask that you "spread the word" to your colleagues that might be interested. All email contacts will be to individual email addresses and not to all at once so that your interest and name is protected until of course we meet. I am aware that some of the recipients of this email are very enthusiastic the enter the program. Others may not be but simply wish to be informed without being associated. Hence the reason for not putting you all on one mailing list. I expect twenty to forty in attendance.

The nearest airport is Jacksonville FL at one hour away, compared to Orlando which is two hour away.

So reserve the date. More to follow.

Stanley V. Paris PT., PhD., FAPTA
President, University of St. Augustine,
1 University Blvd.,
St. Augustine, FL 32086
USA
(904) 826-0084 Voice
(800) 241-1027 Toll Free

From and earlier communication

Colleagues,

Some weeks ago I responded to some interest shown by a number of chiropractors who were interested in earning the Doctor of Physical Therapy degree by sending an email with the following message.

"DC DPT

To those inquiring about the University of St.Augustine and its interest in considering admitting DC's into its online and weekend DPT program. The University is located in St. Augustine north east Florida where it conducts PT and OT campus based programs. However it has commenced a twelve semester online DPT program wherein all the didactic education is conducted online and the laboratory sessions are being conducted at its weekend campus in Boca Raton south east Florida. At this point one chiropractor from Chicago has been admitted into the program. He is taking the entire program and is not testing out any of the courses nor asking that he be granted transfer credit. Obviously these two issues are possibilities. Certainly in the area of radiology, chiropractors have had more education than physical therapists.

The online format is ideal for those who feel they already have the knowledge. There is expected to they will be able to go online and take the tests.

There are a number of issues that will need to be explored. Culture is one of them. Physical therapy is increasingly evidenced based and principally on the patho anatomical model moving to the disablement NAGY model. The profession stresses professionalism and is not hostile to medical and surgical practices other than at times being competitive with them.

Our university will explore this issue very carefully in the interests of patient care. You are now on our email list and we shall keep you informed. In the meantime you may learn more by going to www.usa.edu and clicking on the Flex Program."

The appropriate group within the University has now met and we have come to some conclusions including the following:

1. We know that such a move, admitting large numbers of chiropractors could be a political hot potato in both professions. However if it is best for the patient and best for the professional then it must be considered.

2. We also consider that chiropractors know precious little about physical therapy education and that many may be unaware that the program is in fact quite rigorous and does for instance require a bachelors degree as well as the Graduate Record Exam to be considered for entry

3. Concerns were also expressed as to why a chiropractor would want to earn the DPT degree. If it was solely to enhance billing opportunities that would not be an acceptable reason

4. We also consider that our cultures are different and wonder if chiropractors interested in this educational opportunity will still see themselves as chiropractors at its conclusion or as physical therapists or both

So here is our position for the present:

1. We will admit chiropractors on a case by case basis after the usual interviews .

2. We would be willing to meet as early as next March (now May 6th) with any group of chiropractors that would like to discuss the program and how they might be considered for admission. So if someone would like to make the move we will cooperate by informing inquiries from chiropractors of such a meeting. In the meantime we will not be advertising this opportunity. . In the meantime I think all inquiries should be treated confidentially and individually.

Stanley V. Paris PT., PhD., FAPTA
President, University of St. Augustine,
1 University Blvd.,
St. Augustine, FL 32086
USA
(904) 826-0084 Voice
(800) 241-1027 Toll Free

Stanley V. Paris PT., PhD., FAPTA
President, University of St. Augustine,
1 University Blvd.,
St. Augustine, FL 32086
USA
(904) 826-0084 Voice
(800) 241-1027 Toll Free

[Jeff Hebert, DC]

Louie,
Granting advanced standing to chiropractors in PT programs is not out of the norm. What exactly do you find objectionable in this practice? Do you feel that chiropractors should repeat classes such as anatomy, radiology, biochemistry, etc.?

Jeff

[Britt]

For those interesting in the history of the MD move on DOs in California in 1960-61...here's a blog site that summarized the legislation (proposition 22) in California:
http://forums.studentdoctor.net/archive/index.php/t-109334.html

The DO school became UC Irvine medical school. The DOs paid $65 to change their licenses. More details and the history is complex and interesting. The D.O.'s: Osteopathic Medicine in America by Norman Gevitz has a nice summary of the politics.
I don't think anyone is taking over anyone here with The University of St. Augustine, but the reflection is interesting.
Britt

[Louie Puentedura]

Jeff,

I would not have any objections to an individual chiropractor being granted advanced standing in a PT program, as long as that individual's chiropractic college transcripts and subsequent clinical experience were thoroughly scrutinized and evaluated.

What I would find objectionable is a blanket offering of advanced standing to all chiropractors, regardless of the school they graduated from, their clinical experience, etc. There may well be several chiropractors who would need to revisit their anatomy and radiology. As long as it is on a case by case basis, I wouldn't have too many concerns.

Louie

[Jeff Hebert, DC]

Fair enough Louie, thanks.

Jeff

[David Penn]

Have any PT's thought about going to Chiropractic School? I have. With our profession moving towards "true" direct access at such a slow pace, I was thinking that the quicker way to get direct access is to become a DC. This would allow direct access to the public with the ability to compete in the free market for patients, become a referall source to MD and vice versa.
I don't think the chiro's would be up in arms about this. It should be noted that chiro's have a greater business focus than do PT's. They are an opportinistic bunch that we could learn from.

Any thoughts?

[Julie Whitman]

All,

This has been a hot topic on the Education Section listserve. I couldn't help but jump in on this one. I will post my message from the listserve here and am looking forward to comments.

______________________________________________________

As stated on a web log on this topic, "What is all the fuss about?".

First and foremost, we have an accrediting body that is responsible to oversee our PT programs. I cannot imagine that Stanley would pursue a program that would not hold up to the scutiny of CAPTE. Additionally, these folks will need to pass a licensure exam just like all of our graduates.

Secondly, as far as "advanced standing" goes, does it not seem reasonable for a university to grant up to a certain number of credits for coursework that has already been completed elsewhere? Do none of our other universities grant credit for prior education?

Next, why are some so resistant to a chiropractor wanting to come over to join our profession? If a DC wants to go through school (an investment of time, energy, and money) to become a PT, what is wrong with this?

Finally, I can sense that some are quite resistant to the idea that learning and professional growth can occur through online work and weekend intensive training. This attitude certainly fits with the traditional model of education from the past. However, as the world becomes more "flat" through the use of advanced technologies, I believe that we will see more and more of this "distance education". It is now easy to have a "face-to-face" meeting with people from around the world through the use of basic and easy to use software. We are no longer restricted to geographical boundaries to have close professional relationships. I am not proposing that first-professional students would no longer need the hands on work done in lab settings, but the DCs are practicing clinicians. Yes, I am confident that there will be things they need to learn "in lab", and perhaps this will vary based on the individual DC and their background, but in many cases I can imagine many cases where!
weekend intensive work, with practice between sessions, and rigorous practical testing would more than suffice to ensure competence.

I realize that this line of thinking is 100% opposite to the views posted by others. Hopefully this post will stimulate more thoughtful discussion on this topic.

Julie Whitman, PT, DSc, OCS, FAAOMPT

[Chris Baker, MS, DC, DACBN]

This is an interesting topic, and a move which I trust is taken with great thought and planning. In a nutshell, short cuts do not pay off. If a chiro wants to be a PT, he/she should be required to meet the standard and take the courses. Equally, if the PT chooses to become a DC, he/she should be held to the same level of competence and take the required classes. One would assume that this program would meet CAPTE requirements, yet one should be sure.

Sure, many credited classes could and should transfer for credit (provided the class meets the requirement of the other profession.) Absolutely radiology and exam techniques could transfer, or pathology or anatomy. Do I agree with “chop shops” where one can take a weekend course and have “earned” the right to practice a new procedure? Absolutely not. This type practice is seen nation wide as well as in Europe where these entrepreneurs are very popular with those who are monetary motivated. Rarely does one find a sincere student take short cuts to learning. I believe that the sincere student will not want to take the short cut to ensure proper education and training to master the subject desired.

I feel down deep that better dialogue between the two professions of chiropractic and physical therapy would be most rewarding for the patient, as both professions certainly have much to bring to the table. Let me explain.

My career started off with a BS from Texas A&M University in BioMedical Science, then completed a MS in Nutrition. This is where I "gained" the bug for research and the grave importance of Evidence Based Practice. I progressed to Virginia Polytechnic Institute which went through a name change to Virginia Tech University where I began the PhD in Nutrition, although did not finish. After completing my class work load and 1 year into my doctorate studies, I felt motivated to transition into the Chiropractic profession leaving a Fellowship program at the disappointment of my graduate board members. My interest in Chiropractic stemmed from the observed effectiveness of manual treatment (specifically the manipulation) and its therapeutic benefit with the musculoskeletal patient. At that time, Chiropractic was the only profession offering manipulation as a method of treatment.

The school I attended had the reputation as "turning out" "medi-practitioners" in the chiropractic profession. Our school initiated the hospital rotation programs for the top 20% seniors upon completion of the mandatory 14 months of supervised hands-on clinicals. For example, the senior intern could choose between clinical rotation programs in orthopedics, neurology, rheumatology or outpatient within various hospitals within the Medical Center.

Currently, I have been practicing since 1991 in private practice and have absolutely enjoyed what I do. I have had wide freedom to practice in settings from private practice to hospital affiliations. Yet, I have had some reservations about my profession. So much so, I chose to enter PT school to earn eventually my DPT. I am finishing my 2nd year as a physical therapy student at Texas State University-San Marcos and have been an Adjunct Professor in the program since 2004.

Without question, I absolutely enjoy and appreciate the direct access and challenges to properly diagnose and treat patients. I thoroughly enjoy the manual aspect of therapy, specifically the manipulation. My treatment programs are EBP and have been. However, I feel that my profession is guilty of what John Childs stated in his October 2005 article titled “Advancing Physical Therapy Practice: The Accountable Practitioner.” John cited Reinersten, and I quote,” 3 ways to lose your autonomy: (1) create a culture that tolerates mistakes and does not deal effectively with colleagues who fail to fulfill their professional obligations; (2) don’t follow the evidence; and (3) permit unwarranted practice variation.”

I can attest, that what I have learned in my chiropractic education of 3 ½ years duration is not the same as what I am learning as a physical therapist student. In lieu of these differences, there is much overlap. For example, the major sciences and exam techniques are similar, though not exactly the same. Many of the terms used are different. The class format is different. For example, a PT upper extremity class covers the range of anatomy, physical exam techniques, and treatment all together within the same class – where my chiropractic profession separated it into separate classes of anatomy, physical exam, treatment, rehab.

Bottom line, I think that many will abuse this system and participate in what Louie cited as a billing advantage to gaining a PT license. Additionally, these two professions have different interpretations of the same words and terms. I can assure you that even though I have 15 years of experience under my belt (which I have felt is soundly neuromusculoskeletal founded), I did not have the neuro experience as I have now learned as a PT student – neuro in PT is significantly different than “neurosciences” in chiropractic. These semantics have been proven to be at the base of much discourse.

In summary, I see that the PT has made a significant impact on the evidence found in therapeutics, specifically with manipulation and its proper use. I feel that the PT profession brings with it a higher quality of respect as well as a higher caliber of evidence. The PT profession contains more unity as a group behind evidence based treatment. I feel that if a chiro takes a shortened version of the education to earn a DPT or t-DPT that he/she would miss many important integrative aspects of the education that contribute to the overall knowledge of the practice parameters, and such admission into the DPT program may jeopardize the quality of the reputation and quality of the expected outcomes in treatment as a DPT. Possibly, the DC would continue to treat along the DC paradigm without fully grasping the integrative EBP goals, and quite possibly bring some of the “bad habits” to the DPT profession (ie subluxation.)

I am rambling somewhat now. Make some comments and I will gladly continue to contribute to the dialogue.

Chris Baker, MS, DC, DACBN, CCN (and SPT)

[Britt]

Great answers from some DCs. If they are interested and ernest in their studies, go for it in a rigorous program. Julie has a great blog. The world is becoming flat and on-line learning is going to be the university of the 21st C. A good read on the down side of online learning is Hubert Dreyfus' book, On the Internet. He is a Philosophy professor at UC Berkeley, who is a Martin Heideggar scholar. The Heideggarians have difficulty with the loss of 'embodied' learning and the whole experience of living, breathing, touching, seeing, feeling etc that comes through 'real' presence of interactive learning at school...
Anyway, Let's see where the chiros go and where Paris goes. Take care.
Britt

[Chad M. Thompson PT OCS]

All,

I given some thougth to the orginal post by Larry which started this dialogue. I feel as a teaching profession which speaks so passionatly about educating our clients and collegues, what better opprotunity. We have known for some time the benefits of manual and manipulative therapy. Offering a professional group the ability to expand their knowldge base and embrace tennates of our profession is putting our teaching into practice. Chiropractor already have expertise in clinical a skills set and I certainly feel we cannot stand in the way of any individual seeking to better themselves.

Personnelly I was one of those PTA's who tried for eight years to return to PT school. I applied 5 times before I was accepted. I felt my clinical practice and experience would aide me in joining the PT ranks. I felt my desire to better care for my patients and advance myself in a career would be looked upon positively. I was told more than once this was not the case. Applicants with better grades and experience in classes like chemistry, biology and physics were considered more prepared for the profession than I. Despite logging more than 6000 hours in PT and nearly 120 hours in continued education proir to applying, I was considered a only a fair candidate to complete the program. I have Terry Malone, Stewart Ware and Marlene Deshluare to thank for providing me an opprotunity to become a PT.

That said, When one has the skills, desire and will to advance thier competency and skill; why stand in their way?

For to long many of us, myself included have worried to much about our slice of the pie. Lets capitialize on an opprotunity to learn from one another and put well rounded evidenced based clinical education into practice.

Chad

[Elizabeth A Rodela, DPT]

When i was made aware of this recent consideration for DC's, i was taken a back. As a recent graduate of USA, i thought that i was reading an incorrection. at school, we were taught that PTs and DCs were on different ends of a rehab spectrum. we were taught that chiro theories were not realistic to how therapists provide treatment. it would be interesting to see how the students would interact. also, how the therories of manipulation and adjustment would mix with a PT and DC in a clinical setting.

[Jon Newman]

Hi Elizabeth,

I think the PT profession has to first put forth a theory as it pertains to adjustments in order for there to be a comparison. I'm working on a solution to that at http://www.somasimple.com/forums/showthread.php?t=1995 if you or any other readers here are interested.

[Jason Beneciuk]

In a message dated 1/30/2006 2:38:52 PM Eastern Standard Time, sparis@usa.edu writes:

WHAT MIGHT NOT HAVE BEEN CLEAR IS THAT THIS IS NOT A T-DPT BUT A 12 SEMESTER DPT FOR POST BACCALAUREATE - AN ENTRY LEVEL PROGRAM

I would appreciate this response being posted to anyone who has heard of the meeting that we are planning to have with chiropractors interested in transitioning to a DPT degree. For a start we are not the only school looking at this issue and the other program has been looking at it longer than us. While I have historically fought chiropractic, no doubt more than any other therapist, and have spent quite a few dollars and much time in the process being sued by them etc. both in New Zealand and the United States, I have always felt that our best defense was to strengthen our own profession and defend against incursions by them while at the same time not speaking ill of them.

Basically chiropractors are of three groups. The super straight, straight and those using EBP. Most schools are tending towards the straight to EBP model but most students are in the super straight and straight schools. There is a growing realization in chiropractic that EBP is the way reimbursement and practice is going and that where they need to be. The schools might be less concerned than the clinicians. But today's EBP chiropractor, is at least in the musculoskeletal area, not too far removed from physical therapy practices. Given that five years after graduation only 50% are practicing as chiropractors there are a great number that have left the profession for whatever reason(s).

We already have one DC in our 12 semester online and weekend lab DPT program based in Boca Raton. He is taking all the courses and not” clepping out” or transferring credits in any way. He is a student in every sense. We are calling the meeting to which you refer to look at all the issues involved in allowing these persons to become PTs. Culture is foremost and so is EBP. Paying attention to those aspects I believe we will find many a candidate that will make an ideal DPT. Today, sociologists predict that most young people will have three careers. I am sure that if a DC wishes to become a DPT such a career move will serve them well and serve well those in need of their services.

Do consider that if the likes of Richard Erhard PT., DC who has worked and researched with Tony Delitto as well as being a founding member of AAOMPT and the first president of IFOMT (International Federation of Orthopaedic Manipulative Therapists), then while there might not be other Dr. Erhards there are still many fine DC's that would make excellent DPTs. We are just considering the process in reverse. Likewise both chiropractors and physical therapists have applied to and been accepted into medical schools. So I have difficulty in seeing what the problem is. We certainly are not teaching them seminars. We have never knowingly admitted a chiropractor to our seminars.

There is no political agenda here but I am sure some will read such into it. There certainly is no "selling out." Any candidate must meet our usual criteria for admission including interviews. Our program has rigor and does graduate an excellent DPT. Personally I feel that I am in good position to both listen to and be understanding of the cultural differences and will assure my profession that should we continue to admit DCs they will be cultured into physical therapy. We are calling a meeting and have made no firm decisions beyond that. We are proceeding slowly and cautiously. Additionally I am aware of my position in this profession and I feel my actions are wholly consistent with that position.

Thank you for your request for information.. Best wishes.

Stanley

Stanley V. Paris PT., PhD., FAPTA

President, University of St. Augustine,

1 University Blvd.,

St. Augustine, FL 32086

USA

(904) 826-0084 Voice

(800) 241-1027 Toll Free

[Terry Larson]

I am glad to see that Dr. Paris has been able to reply to this blog. If this is a typical 12 semester entry level DPT program, I am having trouble seeing how you could not allow whoever met the qualifications in. If an MD wanted to go to PT school - the same requirements would be in place.

[Andrew M. Ball, PT, DPT, PhD]

I'm dismayed, but not surprised, to find that the point of my original post has been taken out of context, and morphed into some kind of anti-DC, anti-Paris rhetoric. That is not the case, and never has been my concern with the DC to DPT program.

Those of you who continued in the discussion would realize that Dr. Paris responded to the PTManager listserv, to which I raised additional questions and concerns, suppored by several other leaders in the profession --- those in states such as Maryland in particular.

My response to the above post by Dr. Paris, forwarded by Steve Tepper, PT, PhD, and as yet unanswered, was as follows:

Steve,

Thank you for getting clarification from Dr. Paris, please pass along
my personal thanks, and the thanks of others on this forum for that.
No one here is attacking Dr. Paris' integrity or commitment to the
profession, and I for one GREATLY appreciate his clarification. To
paraphrase, I'd agree with what Dr. Paris describes as the potential
to find "diamonds in the rough" among disgruntled DC's willing to
disavow chiropractic philosophy in favor of a clinical philosophy
more consistent with the DPT.

I'd like, again, to try to turn people away from discussion about the
ethics or legality of such a program, and refocus upon the idea
of, "Is this a smart move for the profession?" I'm still not
convinced or reassured by Dr. Paris that it is (But I am reassured
that it doesn't sound as though he's completely convinced either).
While I understand and appreciate the potentially positive vision
that Dr. Paris puts forth, there are several doomsday scenarios that,
in my opinion should be judiciously considered. Not in a panic, and
not with any animosity, but seriously considered in a "profession of
physical therapy business plan" or strategic vision sort of way.
Among them are the following:

1. The majority of DPT's are not seasoned clinicians who have
completed a t-DPT. Most are entry-level novice physical therapists.
As the profession moves forward toward autonomous interdependence, we
must consider the potential perils of admitting DC's to DPT programs,
even entry level. This is not to advocate an anti DC bias, but if
the DPT vision is to succeed, it must be considered that DPT's, not
those with combined degrees, must lead the charge. It must be
considered that the vision and motivation of an individual with
multiple degrees may not be entirely loyal to the profession of
physical therapy. Should such a negative outcome be realized, the
DPT vision may be squashed before it ever gets legs. That, I'm sure
even Dr. Paris would agree, would be a shame.
2. It has been argued that any DC who enters a DC to DPT program
would have to pass the same boards as any DPT. This may not be the
case. There are several states, (I believe, and Steve please correct
me if I'm wrong, that Maryland is an example), where DC's are
permitted to advertise "physical therapy" because the term is not yet
protected. The potential for a DC to complete a DPT program as
described by Dr. Paris, but to NOT take the licensing exam, does
exist in theory. Furthermore, the potential for a DC to complete the
DPT program, sit for the boards, pass them, and advertise oneself as
a Doctor of Chiropractic who, as a DC also has complete mastery of
physical therapy, exists as well. My concern is that as DC's
currently have direct access to directly reimbursable patients, and
DPT's do not, that the public can be quickly and incorrectly skewed
into thinking that a DC is to a DPT, as a lawyer is to a paralegal ---
even those DC's WITHOUT DPT training. That, I'm confident Dr. Paris
would agree, would be a disaster for our profession.

Alarmist? Perhaps, but most bad ideas and unintended consequences
begin with a positive vision, full of hope. As Dr. Paris proceeds
with exploration of his vision --- and make no mistake, I support him
in that exploration --- I believe that we as a profession must
encourage him to tread VERY carefully, and judiciously weigh the
potential benefits and value for the profession with very real, very
plausible dangers. I do not question the commitment nor loyalty that
Dr. Paris has demonstrated to the profession of physical therapy over
the years, but I do request that we as stakeholders have a very real,
non-alarmist debate on the issue, BEFORE decisions are made and a
program of this sort encouraged. Concurrently, I'd like to appeal to
Dr. Paris that as he explores the potential of such a program, he
strongly consider less what alarmist PT's may have to say about such
a program --- and more in a business plan nature, about the full span
of potential positive AND negative consequences of such a program,
constantly asking himself, at every stage in the process, and about
every potential outcome (positive AND negative) "Is this outcome
right for the profession?"

Andrew M. Ball, PT, DPT, PhD

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