Re: Direct Access- do we have the education to warrant it

[Guest guest]

Arslanian's comments below made me wonder whether we do, in fact, have the appropriate education to warrant "primary care" status. I think that we do have that education, and then some. If a patient were, in fact, to come into our clinic right off the street requesting our services, I have no doubt that the vast majority of PTs in the field would be well equipped to perform a comprehensive initial evaluation, and provide the appropriate (read "safe" if you like) treatment to address the problem.

The key to this issue seems to be not so much about our ability to recognize the need to refer that patient on to another professional when it is necessary but rather about whether or not we could be trusted to do so.

I believe in our 'profession' and quite frankly, I think that it's about time we were allowed to 'act professionally'. Direct access does not mean we will turn our back on referral/consultative relationships. Quite the opposite will occur, I believe. When we gain true 'direct access' status, we will find ourselves in greater referral/consultative relationships.... because we will finally be on an equal footing and there will be mutual respect.

Emilio "Louie" Puentedura, GDMT, PT, OCS

S.W. Rehabilitation Associates

Re: The cost of orthopedic post-op rehab -Reply

> I worry in fact that our zeal about direct access has> allowed those who would disparage our profession to portray us as> eschewing referral/consultative relationships, instead preferring> (arrogantly some would say) a "primary care" status for all our patient> contact without the education to warrant it. This worries me

> Arslanian, MS, PT> Director of Rehabilitation Services> Brigham & Women's Hospital> Boston

[Guest guest]

And don't forget the concept of Natural Selection. Survival of the Fittest ,eh?

Ken Mailly, PT

PAR

aptanj

President

Mailly Consulting Inc./RPA

Re: Direct Access- do we have the education to warrant it

Arslanian's comments below made me wonder whether we do, in fact, have the appropriate education to warrant " primary care " status. I think that we do have that education, and then some. If a patient were, in fact, to come into our clinic right off the street requesting our services, I have no doubt that the vast majority of PTs in the field would be well equipped to perform a comprehensive initial evaluation, and provide the appropriate (read " safe " if you like) treatment to address the problem.

The key to this issue seems to be not so much about our ability to recognize the need to refer that patient on to another professional when it is necessary but rather about whether or not we could be trusted to do so.

I believe in our 'profession' and quite frankly, I think that it's about time we were allowed to 'act professionally'. Direct access does not mean we will turn our back on referral/consultative relationships. Quite the opposite will occur, I believe. When we gain true 'direct access' status, we will find ourselves in greater referral/consultative relationships.... because we will finally be on an equal footing and there will be mutual respect.

Emilio " Louie " Puentedura, GDMT, PT, OCS

S.W. Rehabilitation Associates

Re: The cost of orthopedic post-op rehab -Reply

> I worry in fact that our zeal about direct access has> allowed those who would disparage our profession to portray us as> eschewing referral/consultative relationships, instead preferring> (arrogantly some would say) a " primary care " status for all our patient> contact without the education to warrant it. This worries me

> Arslanian, MS, PT> Director of Rehabilitation Services> Brigham & Women's Hospital> Boston

[Guest guest]

I completely disagree with Louis' statement that the question isn't whether or not PTs can recognize and refer patients appropriately, but should they be trusted. I believe that the question should be whether or not PTs in general have the ability to recognize when and where to refer. I don't think that most do, or at least the PTs out there that I've interacted with.

For instance, the PTs at the local county hospital outpatient dept are always extrememly confused about what to do with a consult that says something like "Shoulder pain, eval and treat," or take for instance the recent problem that one encountered when a patient was referred for a shoulder impingement, but it is evident to her that this is not the real problem. As she stated, "It's some kind of nerve thing, like TOS." She wasn't sure what the problem was and was wondering whether she should continue to treat the "shoulder impingement, or contact the doctor with her soncerns. From the description she gave, it seemed very obvious that this patient has a cervical radiculitis, and she had no idea what she was doing administering the TOS tests. She had most of them wrong, not to mention the debate that still surrounds this controversial diagnosis. This situation is very distrubing to me, but these two dilemmas represent the state of function of most orthopedic PTs that I have run into outside the Army. It's hard to understand, and everyday I appreciate the education that I was given more and more, even though at the time I felt that much of it was not necessary.

Now, on the other hand, if PTs were forced to take some additional testing in his/her area of expertise, and additionally have a couple of years experience (although I had direct access 6 months after completion of training) then the debate might be different. The physicians that I work with trust me and my judgement, and I have had no problem proving my expertise in musculoskeltal conditions, as they often complain that I am speaking a little over their heads. However, give me a sinus infection or an upset stomache and I'm screwed!

Guy Terry, MPTReynolds Army Community Hospital

Fort Sill, OK

Re: The cost of orthopedic post-op rehab -Reply

> I worry in fact that our zeal about direct access has> allowed those who would disparage our profession to portray us as> eschewing referral/consultative relationships, instead preferring> (arrogantly some would say) a "primary care" status for all our patient> contact without the education to warrant it. This worries me

> Arslanian, MS, PT> Director of Rehabilitation Services> Brigham & Women's Hospital> Boston

[Guest guest]

Well, Guy, if I had the kind of experiences you relate here, then I would feel the same way as you. Luckily, I have encountered many more competent PT's rather than bewildered ones. I sincerely hope that the vast majority of PTs are better than you have encountered, and if they are not, what can we do to change it. Perhaps we need to have all PT's undergo some kind of regular competency exam? As an orthopedic specialist, I know I'll have to re-sit my certification in a few years, so I'll keep up to date and be ready for it. What about a similar kind of challenge for all PT's? Surely one's education shouldn't end upon graduation?

Louie Puentedura, GDMT, PT, OCS

Re: The cost of orthopedic post-op rehab -Reply

> I worry in fact that our zeal about direct access has> allowed those who would disparage our profession to portray us as> eschewing referral/consultative relationships, instead preferring> (arrogantly some would say) a "primary care" status for all our patient> contact without the education to warrant it. This worries me

> Arslanian, MS, PT> Director of Rehabilitation Services> Brigham & Women's Hospital> Boston

[Guest guest]

,

you wrote:

> But I do believe that our wonderful training IS sufficient for all of us

who

> care to do the continued learning necessary to Rx w/ direct access.

> Those who can't do that should not even be practicing in outpatient PT,

> again IMHO.

>

> Sorry for the verbiage; I feel stronly about this.

>

I agree wholeheartedly. But how do we remove those PTs who wont/ dont keep

up with their continued learning? Perhaps quality CE should be a mandatory

thing....

Sincerely,

Louie

> > I completely disagree with Louis' statement that the question isn't

whether

> > or not PTs can recognize and refer patients appropriately, but should

they be

> > trusted. I believe that the question should be whether or not PTs in

general

> > have the ability to recognize when and where to refer. I don't think

that

> > most do, or at least the PTs out there that I've interacted with.

> > For instance, the PTs at the local county hospital outpatient dept

are

> > always extrememly confused about what to do with a consult that says

something

> > like " Shoulder pain, eval and treat, " or take for instance the recent

problem

> > that one encountered when a patient was referred for a shoulder

impingement,

> > but it is evident to her that this is not the real problem. As she

stated,

> > " It's some kind of nerve thing, like TOS. " She wasn't sure what the

problem

> > was and was wondering whether she should continue to treat the " shoulder

> > impingement, or contact the doctor with her soncerns. From the

description

> > she gave, it seemed very obvious that this patient has a cervical

radiculitis,

> > and she had no idea what she was doing administering the TOS tests. She

had

> > most of them wrong, not to mention the debate that still surrounds this

> > controversial diagnosis. This situation is very distrubing to me, but

these

> > two dilemmas represent the state of function of most orthopedic PTs that

I

> > have run into outside the Army. It's hard to understand, and everyday I

> > appreciate the education that I was given more and more, even though at

the

> > time I felt that much of it was not necessary.

> > Now, on the other hand, if PTs were forced to take some additional

testing

> > in his/her area of expertise, and additionally have a couple of years

> > experience (although I had direct access 6 months after completion of

> > training) then the debate might be different. The physicians that I

work with

> > trust me and my judgement, and I have had no problem proving my

expertise in

> > musculoskeltal conditions, as they often complain that I am speaking a

little

> > over their heads. However, give me a sinus infection or an upset

stomache and

> > I'm screwed!

> >

> > Guy Terry, MPT

> > Reynolds Army Community Hospital

> > Fort Sill, OK

> >

> > Re: The cost of orthopedic post-op rehab -Reply

> >

> >

> > > I worry in fact that our zeal about direct access has

> > > allowed those who would disparage our profession to portray us as

> > > eschewing referral/consultative relationships, instead preferring

> > > (arrogantly some would say) a " primary care " status for all our

patient

> > > contact without the education to warrant it. This worries me

> >

> > > Arslanian, MS, PT

> > > Director of Rehabilitation Services

> > > Brigham & Women's Hospital

> > > Boston

> >

> >

>

> --------------------------------------------------------------------------

----

> >

> >

[Guest guest]

Fortunately, I think that there won't have to be any particular "removal system" for therapists that don't keep up with current information or don't extend their education. In the current economic climate, it may quickly become easier to keep competent therapists and let go or remediate those who aren't up to the standards of where they work. A manager in the recent past wouldn't be to prone to push his/her staff because if one therapist quit, they would end up short-staffed. Now, if the manager is dedicated to quality care (that's a big if) therapists have no choice but to improve the quality and productivity of their work. The good therapists meet the challenge, become more competent, and therefore more productive.

I think that today's economic times (in terms of PTs anyway) really make the need for skilled clinicians filling the management positions a must. An RN in charge of the PT/OT/SP departments won't have a clue what's good quality and what's not. An RN or "pure" administrator in these positions also won't have a good idea how to solve these quality issues, if in fact they recognize them at all.

With the amount of "administrative bashing" that goes on, we all need to recognize that having a skilled, even a clinical expert/PhD in this kind of position can be a distinct advantage, especially if this expertise is marketed well in the media and to physicians.

As far as the quality of therapists in the area that I live--there are two Bachelor's programs in the area, one had as many as 25% fail licensure exams the year before last. They had been on probation, and somehow got back off and were able to keep their doors open. The other program seems to be focused on clinical treatment rather than "meat and potatoes" orthopedic and neurlogical evaluation and hard science. There is no research requirement at either school. The latter program will be an entry-level MS program, and will extend the curriculum by a semester, although there will still be no research requirement. I know that Shirly Sahrman has weighed in against pushing research projects, but I guarrantee that the gain that students make in critical thinking by "plowing through" a research program is well worth the extra work. Critical thinking is what makes a physical therapist a clinician rather than just a technician. Critical thinking allows a therapist to acquire new knowledge, and makes them less susceptible to "pseudo-science."

Guy Terry, MPT

Re: Direct Access- do we have the education to warrant it

,

you wrote:

> But I do believe that our wonderful training IS sufficient for all of us

who

> care to do the continued learning necessary to Rx w/ direct access.

> Those who can't do that should not even be practicing in outpatient PT,

> again IMHO.

>

> Sorry for the verbiage; I feel stronly about this.

>

I agree wholeheartedly. But how do we remove those PTs who wont/ dont keep

up with their continued learning? Perhaps quality CE should be a mandatory

thing....

Sincerely,

Louie

>