Professional Parity between PTs and Doctors: IAP on track - way before APTA!

Just signed on to the hospital EMR. I am reviewing a patient that I am consulted on for opinion. The system asks me to establish my relationship with the client. The options for me are: "Ancillary Services, Chart Review, and Clerical". I smirk at this distinction.

Which brings me to the Holy Grail of autonomos practice. The concept of "Autonomous Practice" - or "Direct Access" has been floating around in the US for the better part of at least, the last 2 decades. Much has been done in this regards, but true implementation has been lagging.... Which I define in terms of reimbursement, social status, and be able to control our own specialty, without being considered "under direction of a physician".

In context of Direct Access, the focus of the American Physical Therapist Association (APTA) and the majority of the proponents, has been, and continues to be in the out-patient domain. This is unfortunate. Expert physical therapists in the medically complex, acute care setting, have already set a trend of practice that can easily be construed to be the closest descriptor of autonomous practice as conjured up in Vision 2020 of the APTA. So much so, that there are discussions in the acute care section of creating the latest (and Greatest?!) board-certified specialty in acute care practice. Acute PTs are not just helping diagnose patient problems, they are instrumental in directions for work-up, disposition, and placement for patients in that domain.

A patient may not be admitted or transferred to a rehabilitaiton hospital without the PT consenting to a clinical need (save Medicare enrollees). The orthopod and the PM&R physician very rightly do not have privileges to influence disposition of privately insured individuals unless PT is on board. It is extremely interesting how these PM&R physicians make it seem that they are waiting for the PT input in making their decision, all the while basing their entire evaluation off the PT consultation report. Yet the hospital EMR system is set up to relate to us as "ancillary services"!!


The United States prides itself on the highest bastions of PT education, ethics, title protection, and consumer protection. The entry level criteria for PT practice has been continually upgraded to now the doctoral level. Yet, the APTA has been sadly unable to separate the practice of Physical Therapy from the confines of "ancillary services". This topic alone merits discussion of its own.

But this post is about seeking parity with primary medical services and how we contribute to healthcare as PTs. Just like the APTA, the Indian Association of Physiotherapists (IAP) has long been in the process of title protection, turf protection, and similar challenges. I concede that progress has been slow, but the graduates of Indian Physical Therapy schools (Physiotherapists) have been legally able to use the title of doctor, for quite some time now. Now this new development from the Indian subcontinent, is a giant step forward towards establishment of PT as a parallel medical profession, not to be construed "under direction of a medical doctor".

While we continue down the path of Vision 2020 and Direct Access for PT, we need to unshackle ourselves from the dominating domain of medicine, especially those of Physical Medicine and Rehab. But then, that is another discussion....

Cheers
Acute PT