Doctors of Physical Therapy in 2036

Several individuals sent me the link to this article today regarding the future of chiro and the DPT. I have now quickly read through twice and can't exactly figure out the implied meaning or motivation behind the piece. One individual suggested the author intended a "wake up call" of sorts to the chiros. They have been threatened by the DPT and inroads to direct access. If history is at all a predictor of the future, I suppose the message is to continue opposing any and all PT legislative initiatives.

I am curious to hear the thoughts of our enlightened blog readers. It's a bizzare portrayal of our future to be sure. Thoughts?

By the way, on a related note, have a look at Dr. Gail Deyle's editorial this month in JOSPT. This is an excellent piece that will be frequently referenced as we watch the future unfold. Excellent insight on the issues at hand, Gail.

John

Comments

[britt smith]

Gail Deyle has written a timely and thoughtful piece on direct access. He touches on the central issue brought up in the fight for direct access (and indirectly about POPTs) in New York recently: Does direct access to PT pose a risk (or threat) to public health? Gail has compelling evidence that direct access is safe and sane.
I find the piece on DPTs of the future amusing. As a member of the AAOMPT committee on public relations, I particularly enjoyed being a 'daring of the media' in the article.
Interesting, that this chiropractic website envisions DPTs evolving into radiograph 'heads', who see the MRI/x-ray and not the patient. Also, interesting that the DPTs are seen as persons without motion palpation skills. In my 25 yrs as a PT, I've witness an increase in motion palpation dialogue in the chiropractic community (examining textbooks). The techniques have been taught and practiced (at least in the Maitland and Kaltenborn schools) in physical therapy since the mid-1950's. Neither here nor there, I don't see us becoming this quasi-physiatrist discussed.
Interesting perceptions and projections. I'm curious what the chiropractic bloggers think.
Cheers, Britt

[Michael DuPriest]

First thing that comes to mind is the continued love affair with the subluxation (only chiropractors can locate)and the magical application of an adjustment that produces amazing clinical changes. By the way the adjustment and these results are only achievable by a chiropractor.

I doubt this characterizes the future of evidence-based PT, but political chiropractic will not let go of the pseudoscience, the Harvey Lillard syndrome. DC's could regress to nothing more than bonesetters and lose all profrossional recognitions. I hope that is not the case, but I have not seen much philosophical change since my entry into the profession in 1988.

Mike d

[Jeff Hebert, DC]

Britt,
My impression of the chiro article was that the author was attempting to provide a "wake up" call to chiropractors, while having little understanding of the physical therapy profession. If recent research on the subject is any indication and experience with manipulative procedures does not improve clinical outcomes, the "double secret" set of chiropractic techniques may be meaningless.

Jeff

[Dan Pinto]

Mike great comments. I found the following lines interesting: "Through stifling legislation, the end of student loans and other fiscal blows, the chiropractic schools had started physical therapy programs in order to survive." The book "Spin Doctors: The Chiropractic industry under examination" refers to legislation as the main source of chiropractic inroads into society. It is interesting that this chiropractor fears legislation will be how they are forced out. I'm not quite sure what to think about the chiropractic schools starting physical therapy programs. "The public got the idea that only "medically trained" practitioners could give a "safe and evidence-based treatment." So, he has heard the term - I do believe embracing evidence whether or not chiropractors are "medically trained" will be what keeps them around.

[Michael DuPriest]

Hi Dan

I am not aware of DC schools starting PT schools. The DC school I went to in the 80's has changed their name from Logan College of Chiropractic to Logan University.

While reflecting on the topic this morning it brings to mind the importance of embracing the evidence to drive our (PT) profession and practices. If PT chooses guruism can the expectation for a different outcome (the current chiropractic quagmire) be expected? I think not. Hopefully the DC profession will chose EBP, but history both recent and past tends to suggest otherwise.

Mike d

[Carina Lowry]

Dr. Deyle has raised great points regarding the effectiveness of a PT to screen for serious pathology, know when to refer to a physician, and order appropriate imaging. As the legislative barriers come down, our profession must step forward to become a doctoring profession.

I am really not sure what to make of the last Samurai portrayal of the chiropractor giving a deft "adjustment" to the atlas and curing the problem with one final karate chop. I'm not knocking manipulation. It's been shown to be effective in many cases...however the visual of the forgotten warrior was just too much.

I also think this is a great time for everyone to register for AAOMPT the "darling of the media" which is funny since I'm also on the PR committee for AAOMPT. So hopefully everyone will take this opportunity to go online and register for conference in October (or you can print it out and mail it in or fax it in).

Here's to a doctoring profession that actually has good manual skills!

Carina

[Alex Koszalinski]

I'm not sure what the message was the author was intending to send with this piece. But the overtones of a wistful air of a dying profession he tried to create does make me chuckle.

I have to say that I'm a bit offended by the insinuation that a room full of DPT's would not know that dysfunction in the upper 3 cervical segments can produce dizziness. I'm a bit surprised that the author also doesn't believe that we possess the knowledge and skills to examine and treat the upper cervical. Based on this article alone, I would say the author doesn't have a good understanding of the knowledge and skills that PT's possess (DPT, MS or BS trained).

Alex

[John Raymond]

I think you'll find resistance from the MD/DO in time, just as DCs have when trying to gain access in the VA. Funny how the DOs were marching against the DCs when they themselves had the same dilemma decades before.

It going to be about the competition and many DPTs in solo practice will find that the Medical clinics will be refering to their "own" PTs in order to keep the profits local.

MDs are now trying to pass laws to keep any other healthcare provider from doing what the call "working inside the scope of medicine." Even now they are trying to keep DCs in Texas from performing needle EMGs.

It'll be a rude awaking for folks running thier own business just how money becomes the driving factor in referrals and the like, the heck with results. DCs know this well.

PTs have been spoon fed patients forever and many when faced with the task of having to actually run a business will find reality isn't so easy. Many will fail either because they are not business savvy, or have the personality of a fish and if you think getting great results is all you need to survive, then a wake up call is in order.

Some of the worst docs I know are busy due to thier way with people. Once in private practice your main job will not be doctoring, but marketing.

Exceptions, now sure, but wait until the market is flooded with DPTs.

It'll be interesting to watch.

[Jason Silvernail]

John-

Most estimates of the supply/demand indicate that there are more jobs for PTs than the schools can fill.

While your own profession may be saturated (according to it's own members), this doesn't appear likely in the PT world.

I don't think anyone will dispute the challenges of marketing a practice, but to call referrals from other practitioners "spoon feeding" is uninformed and quite disrespectful.

We all share the problems and issues inherent in legislative battles over scope of practice. Some of us have mounted a more broad-based improvement backed with research evidence of efficacy than others, and I think that may be the deciding factor. The market is in flux, and we all look forward to what the future will bring. A future, incidentally, that will have little to do with this ridiculous story of the year 2036.

Jason.

[John Raymond]

Too conclude that all DCs cling to old tenets and science is wrong. The majority of DCs have been aware of the research as much as anyone. In addition, the move away from just passive care is obvious with the fact that most know long term control of a problem requires patients to take control of thier health and DCs promote this. Many start thier own rehab program.

The doomsday talk about DC dwindling away began as soon as the first adjustment was made and seems to continue today. Thier was an immediate split between the cult-like and the science-based.

The fringe folks in our profession that cling to pseudoscience happen to be the most vocal and hence may appear popular. But they are a minority and DCs like myself would like nothing better then see them split off into thier own fantasy world.

Refering often to PTs I get some interting comments back from pts in regards to questionable science (like a rotated L3 that's corrected with a little pressure/manipulation?) So it (pseudo science) must go both ways.

I am no more threatened by the DPT, then PTs are by DCs. Although, it seems, by some of what I read here thatit appears thier are some who like nothing better to do then denigrate the profession, which translate to fear IMO.

My state dosen't allow DCs to do PT (modalities anyway) and I refer quite often with good report for the most part.

As a side note, just because you are taught to manipulate dosen't mean you can (physically). Just like DCs many graduate and never have the "Knack." I assume the same will happen to PTs as well.

After they hurt one or two pts, they may just refer them out if manipulation is indicated. Or, as often happens, let thier ego get ahead of thier pts well-being, and not refer.

This should not be tolerated in any profession.

I hope the future will bring us together, because I feel the DPT will soon get more flake from the AMA when they see that they are taking away from thier interest (read: profit)

[John Raymond]

Jason, no disrespect intended. By spoon feeding I just mean, compared to DCs, we rarely get the referrals you do. Since in my state PTs can not adjust, you would think we would get pts that this may be indicated.

Mind you I have had pts who were referred to a DC, but for the most part they are self referred.

Again, don't take it personal, I never meant it that way.

[Jason Silvernail]

Fair enough, John.

There's enough venom on both sides of this fence as it is anyway, right?

I share your desire for collaboration in the interest of the patient.
J

[Dr.David Black]

Chiropractic has it's own unique philosophy and has existed for over 120 years now.
The future therapists will certainly include chiropractors in their midst.

[Eric Montgomery]

Check out this excellent article on how Physical Therapists need to be part of the Healthcare Reform Equation. http://www.lighthousecareeragents.blogspot.com

[San Diego LASIK eye surgery]

I see a large and positive change coming for Physical Therapy, its a very necessary practice.

[Physical Therapy Supplies]

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[Medical health videos]

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