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  • #46
    Hi Diane and Nari,

    I consider PTAs my coworkers. They are part of Physical Therapy. Personally, I use them as little as I can but that's because I like to see my clients from evaluation to discharge. One of the major barriers to advancement for PTAs is their Associate degree. But there are PTAs who have earned and undergraduate degree while continuing to work as a PTA. However, there doesn't seem to be much of an avenue that is especially supportive of them moving toward a PT degree (in its various forms.) No credit forgiveness, no helping hand as far as I understand.
    "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

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    • #47
      Thanks Jason, You laid it out very clearly. Looks like becoming "Dr." is the only way out of the tenth circle of hell for PTs in the US.
      Nari, in Canada podiatrists and psychologists are also "Dr."s.

      I guess our autonomy (as PTs in Can.) has kept us from being sucked into that vortex for a long time. Yet, our whole health care system seems to be slowly starting into a downward spiral down the toilet and into the same sewer the US one is in. It's becoming all "two-tier" - of which there are many European models to emulate, and an Aussie one, but when we have conservative governments, they usually want to do everything American style... so for now we are scr***d.
      Diane
      www.dermoneuromodulation.com
      SensibleSolutionsPhysiotherapy
      HumanAntiGravitySuit blog
      Neurotonics PT Teamblog
      Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
      Canadian Physiotherapy Association Pain Science Division Facebook page
      @PainPhysiosCan
      WCPT PhysiotherapyPainNetwork on Facebook
      @WCPTPTPN
      Neuroscience and Pain Science for Manual PTs Facebook page

      @dfjpt
      SomaSimple on Facebook
      @somasimple

      "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

      “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

      “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

      "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

      "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

      Comment


      • #48
        Hi Diane and Nari,

        I agree with Jason. The label Doctor has its uses. However, I don't think that alone is what will get favorable legislation passed and I'd be surprised to find that the label is what the current hold up is. The substantive changes are curricular in nature.

        Just to help clarify our direct access issue. Most states have some form of direct access (regardless of BS, MS, DPT.) One of our current autonomy problems is that reimbursement for direct access is commonly denied. The reality is that if people have a choice of having PT reimbursed or paying out of pocket, they'll go the free route even if it means one extra stop to see the doctor before seeing the doctor.

        Also, having the label is no guarantee that this scenario will change but it might help.
        Last edited by Jon Newman; 09-04-2007, 12:21 AM.
        "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

        Comment


        • #49
          Jason,

          I think you summed up my idea fairly correctly. I don't think it is a "worry", just a prediction. As far as chiros, podiatrists and psychologists not going that route when they adopted the "Dr." title, they also didn't have Assistants doing virtually the same thing they themselves did except for assesments, plan of care type of things. I think a closer analogy would be the introduction of Physician Assistants and Nurse Practitioners, but even they weren't as closely parallel as the PTA and the PT. It is a truism of a marketplace that a person should perform at the highest level they are capable of with regards to skill, knowledge or credentials. For a PT that is largely assesment, but with DPT that will expand slightly to diagnosis and Plan of Care duties as well, I believe the goal is to eventually assume the position that MD's hold in MSK matters now. It is also a truism that the lowest priced, least skilled/credentialed person should preferentially perform any task. Why pay a DPT to do what a PTA can do?

          I think this is confusing to non-US therapists where there aren't these distinctions, but I think they may understand my point as well, if two people can do the same job, why use the most educated, most expensive one to do it? If they can both do the job, why is one required to have more education and higher pay?

          Comment


          • #50
            ...if two people can do the same job, why use the most educated, the most expensive one to do it?
            Randy, that is very true if we are talking about equivalent competence and skills. I assume that the DPTs should be better skilled then the PT, but is it significantly more? Here they are specifically skilled in one or two areas, precisely in areas of the thesis interest/s. A PT has more general skills.

            I think it depends very much on the definition of the 'job' in question.
            However, some way has to be found to pull USA PTs out of the bureaucratic bind they are in. In the hospital system, I gather the preference would be to employ PTs over DPTs if money is at stake. Could be very wrong on that...

            Nari

            Comment


            • #51
              Hi Nari,

              Generally the type of PT degree you have does not dictate your salary, at least not that I'm aware of. Someone can correct me if I'm wrong about that.

              Currently, there is no difference in the PT Practice Act between DPTs and PTs of other degree standing. There is a difference in the Practice Acts of PTs and PTAs. Because of this, I don't see things unfolding as a shift in job descriptions. At least not without a simultaneous shift in practice acts. I don't see there being three Practice Acts (DPT, PT(other) and PTAs) but I suppose there could be.

              While there has been a curriculum change for MPT to DPT there has not been one in the PTA degree that would suggest that they could achieve a shift in the Practice Act that would allow a shift of job description (as far as I know.)
              Last edited by Jon Newman; 09-04-2007, 04:18 AM.
              "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

              Comment


              • #52
                Hi All,
                To me, the only people entitled to the title of doctor are
                1. Those who have graduated with at least a MBBS (bachelor of medicine;bachelor of surgery) which is the basic medical qualification for a G.P.
                2. Those who have completed a PhD in any discipline whatsoever.

                The rush to become recognised as 'doctor' is really rather amusing if you think about the history of the term.

                Did you know that orthopaedic surgeons, until about 15 years ago, were addressed as 'Mr'? Compared to the local GP, mechanic or other skilled tradesman, specialist medical professionals were considered gentlemen. When I had a fracture, the orthopaedic surgeon absolutely insisted on 'Mr'. I think it was the Americans who revolutionised the form of address for medical practitioners. This has followed on for other health professionals.

                All specialists (including orthopaedic surgeons) may not behave like gentlemen. However, I wonder when they will get sick of sharing the title of 'Dr' with so many other health professionals. Then there will be another shake-up of titles.

                Jane

                Comment


                • #53
                  Oh , so late to catch this Discussion :

                  The same problem here with the public regarding the title "Dr." It is a cultural problem .There is no direct access here to physiotherapist from the official point of view because any accrediting Authority for physiotherapists at the end complies with an authrity forumlated by doctors whom are not ready to lose power /authority .
                  I do NOT know why this title has that magic effect ,despit patients with experience they prefer to deal with physiotherapists .
                  Pharmaciests and dentists have the legal permit to use this title .......To avoid the tile Dr. being a problem ..I believe it has to be legal only for those whom obtain PhD .

                  Emad

                  Comment


                  • #54
                    Well, of all the elements of Vision 2020, the DPT/Doctor thing is what gets the most amount of controversy.

                    There are even some parts of the US PT population that aren't big supporters.
                    I think most people in this group have an opposition to the use of the title, and like Jane S, they have their own personal opinions about who should use this title and who shouldn't. I can understand that point of view.
                    However, no less an organization as the Institute of Medicine has argued that privileges for non-physician (for our chiropractic readers "physician" refers to a medical doctor) health care providers should be enhanced along with the rigor of their education and standards of practice. Maybe the Commonwealth countries like Canada, the UK and Australia have a great system and the competition among providers is more of an even playing field. That's great. But that's not what's happening in the US.

                    If you look at the transcripts of some famous legal decisions against PTs, you can see the weight of the title in the arguments. The most recent case is described http://www.chiroweb.com/archives/21/05/09.html. Read the last sentence from that chiroweb article a few times. It says [emphasis mine] "Other state boards are encouraged to follow Arkansas' lead to ensure that the chiropractic profession is protected, and that the ability to perform spinal manipulation and adjustments stays in the hands of doctors of chiropractic." So, on the "who should be called doctor?" thing - that ship has sailed. Wake up and smell the attacks on scope of practice.

                    I too find it sort of funny that here in the states we have to get a doctorate to do something folks do very successfully in Commonwealth countries with bachelor's degrees. That says a little bit about perception, about legislative history, about anti-PT agendas, and about american culture all at once. But then, as Jane S points out, you can say the same thing for our physicans (MD) versus theirs (MBBS).

                    In the end, we will look back on all this concern over title and realize it was much ado about nothing. My family practitioner doesn't refer to himself as "doctor" out of the clinic, and my cousin the PhD in marine biology doesn't outside of her field, either. I think it will turn out to be a non-event, but it's significant as it takes away a key argument used to restrict our practice. The argument never had any real data behind it, but now it's even less appealing for legislatures. We'll see how things go from here...
                    Jason Silvernail DPT, DSc, FAAOMPT
                    Board-Certified in Orthopedic Physical Therapy
                    Fellowship-Trained in Orthopedic Manual Therapy

                    Certified Strength and Conditioning Specialist


                    The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

                    Comment


                    • #55
                      Well , every time I think of those humans behavior ,the evolution be evidenced again and again . In spite of the civilization , every time humans act like being live in wildness ...Who takes first ..who is fastest ...who is strong previal ..no doubt in spite of the contuning organising of societies .

                      I have an idea ...Physicians are interested so much calling themselves "Doctors" ..why not call ourselves "Professors " .They call themselves as they like ...and we have the same right .

                      Searching for the title "Doctor " history gives out the following http://en.wikipedia.org/wiki/Doctor_%28title%29:

                      Doctor means teacher in Latin. It has been used continuously as an honored academic title for over a millennium in Europe, where it dates back to the rise of the university. This use spread to the Americas, former European colonies, and is now prevalent in most of the world. As a prefix — abbreviated "Dr" — its primary designation is a person who has obtained a doctorate (that is, a doctoral degree), which, with the exception of higher and academic doctorates
                      From the nineteenth century onward, "doctor" has been commonly used as a synonym for "physician" in Anglophone and many other countries; this term is commonly used as a title of address for physicians, whether or not they hold a doctorate. The primary medical qualification in the UK and in many Commonwealth countries are the 'Bachelor of Medicine and Bachelor of Surgery' degrees (MB BS, MB BCh, MB ChB, BM BCh or MB BChir, depending on the University granting the award). In the UK the title "Dr" is officially conferred by the General Medical Council to graduates whose names are included on the list of 'registered medical practitioners',

                      By the way , I do not know If Chiros are medical schools students or not ? seems strange ..but we have no of them ...

                      Noway ,no change ..what happened took place ..Searching for the word "Doctor" gives many choices doctor of
                      Doctor Of Physical Therapy interred the history ....Just sometimes in USA i think patients will search DPT ...

                      cheers
                      Emad

                      Comment


                      • #56
                        Thanks emad- a quick search of the history of the term "doctor" is enough to realize how non-medical it really is.
                        And perhaps how silly arguments over such things truly are...
                        Jason Silvernail DPT, DSc, FAAOMPT
                        Board-Certified in Orthopedic Physical Therapy
                        Fellowship-Trained in Orthopedic Manual Therapy

                        Certified Strength and Conditioning Specialist


                        The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

                        Comment


                        • #57
                          You are welcomed Jason

                          The coming century is the century of Minorites because they will reflect on their experiences


                          Emad

                          Comment


                          • #58
                            Emad:
                            I do not know If Chiros are medical schools students or not.
                            No, they are not. They are physician impersonators who managed to legalize themselves just over a century ago in the US when it was still the wild west; no one knew what they were doing, no one was in charge yet, when actual "medical" practitioners/doctors had no good tools yet to set them apart, like vaccination/public health/antibiotics/anesthesia. It was nomenclature misfortune that became legal-ized, and that everyone's been living with ever since. The U.S. solution seems to be, let's turn everyone into doctors then - if one group managed to acquire the social camouflage that goes with the title, then every group should have the right to the same camouflage.

                            By way of contrast, the osteopaths (D.O.'s) in the U.S. decided collectively to acquire actual medical training alongside osteopathic training. In the U.S, they are therefore true physicians. Check out the Flexner Report, which tried to standardize the mess that existed in the U.S. in the early part of the century.
                            When Flexner researched his report, many American medical schools were "proprietary," namely small trade schools owned by one or more doctors, unaffiliated with a college or university, and run to make a profit.
                            Chiropractic schools apparently wanted to retain this particular facet, i.e., keep schools private and run to make a profit. They decided to keep the doctor title while they were at it, turning the whole profession into a non-cooperating social renegade, a perception they usually manage to flip around and pretend is instead the true representative of health, wealth, wellness, truth, goodness, free enterprise, God, the American Way, etc etc., that has become largely a sociological phenomenon that exists mostly to separate people from what's in their wallets at every step from training to treatment.
                            Diane
                            www.dermoneuromodulation.com
                            SensibleSolutionsPhysiotherapy
                            HumanAntiGravitySuit blog
                            Neurotonics PT Teamblog
                            Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                            Canadian Physiotherapy Association Pain Science Division Facebook page
                            @PainPhysiosCan
                            WCPT PhysiotherapyPainNetwork on Facebook
                            @WCPTPTPN
                            Neuroscience and Pain Science for Manual PTs Facebook page

                            @dfjpt
                            SomaSimple on Facebook
                            @somasimple

                            "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                            “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                            “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                            "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                            "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                            Comment


                            • #59
                              I tend to agree with Jane that the only group entitled to use the name 'doctor' are the PhDs, but the MBBS lot altered that a long time ago.

                              I think only the USA PTs are in a tizz about it; and I understand that comes from a traditional stance that doctors of medicine need to tell PTs what to do and how to do it. The long slog of history has come up against them.

                              Very few people here who are 'able' to call themselves 'doctor' actually do. They do not sign their name as 'dr' nor do they answer phones as 'dr.X'. This included the PhDs.
                              They simply do not consider it anything of importance. It is a good example of the difference in culture and history.

                              Nari

                              Comment


                              • #60
                                Hi all,

                                I thought I might provide a slightly different perspective on this same story.

                                Having recently graduated from a DPT program, we were told that another large motivator behind the transition from Masters to Doctors was that a Doctoral degree was a better representation of the number of credit hours achieved beyond a Bachelors. Here is a link to the Program that I attended DPT_cirriculum. Unfortunately, it does not list the total number of credits, but I believe it was in the neighborhood of 120. According to our Director, a number of Masters degrees are achieved with 30 credits.

                                Of course, none of this speaks to the fact that I have learned more relevant info from this site in one year than I did in 3 years of PT school, but that's a whole seperate thread.

                                Wes

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