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Open question to PTs…

In your opinion, what is the one thing you would change about PT and why?  

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16 replies »

  1. I would like to see reimbursement for services based on completion of residencies, fellowships, specialist certifications, or pre-approved CEU’s in that field (or a combination). I do certainly understand the value of experience and that there are excellent clnicians who are not “specialists,” however I have seen a number of clinicians who simply get cheap and irrelevant CEU’s to maintain licensure as opposed to become better clinicians. The frustrating thing is to know that those same clinicians continue to recieve the same fee schedule as a clinician who has invested their time and money in furthering their didactic and clinical skills to a specialist level. Is it fair that an entry-level PTA can bill the same amout for a visit (after eval) as a 10-15 year experienced PT who has a specialist certification? Or a new graduate? (with due respect, we’ve all been there). If you were a patient, who would you want to go to if you were paying the same amount? Just like in medicine, specialists recieve higher reimbursements than non-specialists, partly because of the time / financial commitment and training that they have put in to excelling in their craft. In PT school, you “learn a little about a lot.” With a specialty area, you “learn alot about a little.” Let’s dis-incentivize the companies who hire cheaper PTA’s to do the grunt work, and pay huge dollars just for someone to do the eval and sign re-eval papers every so often. Let’s stop hearing patients come to your clinic for a second / third opinion and tell you how much “better and different” you are than the last therapist they went to. These changes would encourage employers to seek out the best clinicians they can to recieve top dollar for services.

  2. Great question Joseph!
    HAVING LEARNED A LOT BY HAVING A FULL SKELETON especially regarding upper cervical, costotransverse and costocorporal joints, the subtalar, etc, joints that are hard to visualize in a 3-d manner in a book, 1. I would think that keeping the MOBILE skeletal models readily available throughout the training, not the wired models would be very helpful. 2. Repeat fundamental skill sets such as how to perform an articular spring test. For reasons that escape me, that is a missing skill set that seems to intimidate perhaps, is not practiced as a normative part of an eval to any region. I conclude this by teaching seminars around the country. Of course some schools are very skilled in teaching this, may have to do with faculty as much as curriculum. 3. teach viscoelastic creep treatment to joints especially those that are full of dense connective tissue. I am astonished that in some schools a grade V manipulation is taught to joints that require low-load, long-duration (viscoelastic creep) in order to maximize long lasting change. Some leave their DPT not being comfortable performing grade V yet could be very effective with alternate methods of joint mobilizastion for passive accessory motion loss. A few other ideas are rattling around….great question, I look forward to other answers.

  3. In the current medical system you make more money if you are not very good. I would like to see reimbursement for services to be paid on objective outcomes rather than on processes. If we all used standardized objective performance based outcome measures, then we could calculate efficiency as well as effectiveness and than be reimbursed accordingly. I would like to do away with mandatory continuing education and replace it with mandatory continued compentence.
    Damien Howell PT, DPT, OCS

  4. I would drop this idea that we are somehow mechanics for the human body, operating on people to put things back in place. I’d make physical therapy more “therapeutic”, and emphasize our roles as educators, consultants, and guiding patients through recovery. Not “fixing” them.

    IMO

  5. I wish if there is an international licence for PTs, instead of getting licence from every place u travell to.

    It can save cost, time for people who live in a place but are planning to settle in another place.

  6. Aside from the idea of having an international licensure examination that would qualify one to work in any country, I think having a good standard and well updated curriculum that all universities should follow would ensure competent graduates and produce more effective physical therapists. Some schools are still teaching ancient PT practices such as using modalities all throughout the treatment. Everyone now is moving into the evidence based practice, so why leave the students behind when we can already equip them with the right treatment protocol that really works instead of wasting precious learning time and money.

  7. I would like to see the role of PTs shift from someone you go to after an injury to someone you see before the injury which would fall under more practice autonomy. I really, really like Tony Ingram’s comment. I feel we are underutilized as educators in the community where we could help people to stay healthy. Things like working with youth sport’s team, working with schools, gyms and other community based programs, as well as businesses where repetitive injuries are common. Some PTs already do, but this is an area where PT’s expertise is underutilized. I remember a while back the US military was looking for a personal trainer to help develop a program that would emphasize fitness as a way to decrease incidence of injury. Not to disrespect personal trainers…but many have weekend certifications and have no understanding of the complexity between fitness and injury prevention. This is the kind of thing I would like to see PTs doing.

    I partly agree with Damien in that PTs are rewarded for not being good. And I think clinical competence is slowly replacing the clinical education requirement…though, I am not sure that is going to change anything. I am not convinced the DPT 2020 standard is going to get us paid more or provide more practice autonomy, although it will cost many of us more. Also remember, the US is the only country with a DPT requirement, most countries are still BPT programs. I don’t agree that PTs should be paid on objective outcomes…as there are lots of things that can affect outcomes that are outside the control of the therapist…things like a patient’s diet, their ability or willingness to follow home programs and or therapist’s advice, as well as comorbidities, surgical techniques, and other treatments they are receiving…and on the other end, some patients would improve on their own without PT regardless of treatment technique because that’s the nature of the beast. However, if a patient isn’t getting results they always have the opportunity to see another PT…if their insurance doesn’t severely restrict benefits.

    I also think we need to get rid of this 3 times a week for 4 weeks mentality. Some patients don’t need 3 times a week for 4 weeks. They need 1 time a week for 20 weeks, or maybe 2 times a week for 2 weeks than 1 times a month for the next year. This kind of ties into our role as PTs and practice autonomy. But again, much of this is influenced by insurance and may never change (DPT standard or not).

  8. I like several of the ideas mentioned above, but let me throw out another one. Someone once told me you don’t see doctors working FOR other doctors, they usually are working together. Then they asked my why do other PTs work FOR other PTs. The point he was getting at is that if we want autonomy, we have to think of ourselves autonomously. I know this example is not 100% foolproof, but what I’ve come to realize is that Physical Therapy is as broad as medicine or the body itself. In order to educate our patients, which is the one thing I thought of when I first read the question, we have to be educated. I don’t mean the general, non-specific education we get in PT school. We need to know more and in my experience the more I learn the more I realize I don’t know. I know this is a loaded question in and of itself, but without going on much longer, I think we need to start specializing in PT. I know the APTA offer specializations, but honestly, they don’t mean much to the profession and nothing to the outside world. You could spend a lifetime studying the spine and treating patients with spine problems. Imagine telling your referring physicians, I specialize in the spine, it’s all I do. That would allow us to focus our education toward things we enjoy treating/learning.

    • You know, that’s a good point, Will. I think part of the move towards a DPT standard is to get PTs aligned more closely with the status that docs enjoy in the eyes of insurance companies and that should provide PTs more autonomy and perhaps a greater opportunity to specialize and work together in the way you suggest. Things like direct access are meaningless if insurance companies won’t reimburse without a script/referral. And it isn’t just PTs, it’s pharmacists and other allied health professionals that are moving towards clinical doctorates. I do think that many PTs specialize by default and some successfully market these specializations, even if they aren’t recognized in the same way and even if they can’t charge more because of it. In that sense, a clinical doctorate may pave the way for more meaningful specializations. But you can’t keep raising the bar in a profession (I think specializations and clinical doctorates both fall under raising the bar) unless opportunities are also growing proportionally (something reimbursement and thus insurance plays a critical role in determining).

  9. I would like to see reimbursements based on a flat rate per visit rather than based on procedures and be paid on results. So much time and money is wasted on procedures just for the sake of billing a unit. Let’s do what works and pay for results.

  10. I would like to change patient’s and clinician’s minds on what actually is and causes pain. It amazes me that what we currently know about pain; yet we still hold on to outdated ideas. My pet peeve is getting a referral from an ortho doc and the patient tells me that “The doctor told me that I have arthritis all over my spine. You won’t be able to change the arthritis will you?” Perhaps the degenerative changes in your spine are normal and the arthritis has little or nothing to do with your pain. Yet I feel that I am always walking on eggshells when I educate patient’s about their pain because I don’t want to upset the referring MD. For example, I have treated multiple patients with a diagnosis of plantar fasciitis, when in reality the actual cause of their pain was that darn tibial nerve. After the patient rids their heel of pain in 2 visits with simple nerve mobilizations, goes back and tells the podiatrist what I told them about the nerve. The podiatrist has stopped referring patient’s to our clinic. Unbelievable! I guess I’m supposed to see the patient 3 times a week for 4 weeks and hope they improve with calf stretches and Graston. Anyway, sorry about the rambling but I think I got my point across.

  11. Mis-information and poor patient education. I would like to change the fear provoking explanations and terminology used by all health care professionals. Just this week i have heard the following “My GP told me I have a crumbling spine”, “My last therapist told me my spine is unstable, so i don’t play sport any more”, “my consultant looked at my scan and said ‘ouch, that must hurt’ he said it was one of the worst spines he’d seen – i’m only 35 and I have degenerative disc disease”

    Hearing things like this actually make me angry. I don’t think that any of the above practitioners said those things malicously but they, like so many, do not realise how their words will effect how our patients behave, feel about themselves and their future. Life isn’t much fun if think you may end up in a wheelchair crippled by arthritis. A simple 5 minute explanation negates all of this.

  12. Instead of narrative documentation (often in the form of handwritten SOAP notes first used in 1968) we should record the patient experience using short video clips that could be structured to show Medical Necessity for Physical Therapy and Skilled Therapy.

    Upload the video to low-cost, video hosting servers (eg: YouTube) sponsored by payers, including Medicare.

    If I could drop the cost of paper records I wouldn’t need increased reimbursements. Shedding the cost of paper storage or even electronic versions of paper records would probably net out a 10-15% profit margin! Time for a dividend!, such

    The fact that my profession is required to represent ourselves using handwritten or typed narrative notes from the therapists’ perspective is an embarrassing failure in today’s connected, patient-centered age.

    Worse, many “leaders” of my profession support this model and encourage incremental changes such as the Alternative Payment System that will only perpetuate this failure.

    Tim

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