Professional Encroachment? Part 2

I have noticed that my post titled Professional Encroachment has been the most viewed post on my blog and even made it to first page in Google search  for the term (from what I understand according to my website developer, if you make it to first page Google you have done something good). Perhaps, before I go patting myself on the back, maybe it is because I have touched on a topic which others are not willing to discuss openly. 

According to the Free Dictionary online: Encroachment is a noun and is defined as:

Any entry into an area not previously occupied.

The word encroachment has a negative connotation. Synonyms include invasion and intrusion. People get upset when someone tells them they have encroached upon something.

To put this in perspective, what would your first instinct be if I stood in front of you, put my hands on your shoulders and started to push? My guess is that you would want to push back? Seems natural of course. Now what if I reached into your pocket without your permission and started taking money out of your wallet. You would of course want to stop me. Again makes sense.

But what if I stood by your side and put a hand on your shoulder and pushed you forward? What would your instinct be? Now if someone just asked for volunteers to do something no one wanted to do you might push back. But what if someone said they wanted to recognize the first person to come forward with a reward and I pushed you, would you still push back. My guess is not. Why?

In the first scenario I am standing in your way and pushing you back. From a psychological perspective this is a very confrontational scenario one in which I am "blocking you" by standing in front of you and not only that, but am pushing you "backward." In the second scenario in which I am standing by your side or even behind you, this is much less confrontational and even more of a supportive stance. My push "forward" is an advancement toward something and no longer a push "backward" or "away" from something.

If I have built a relationship with another person and have permission, whether implied or through direct communication, to enter the space they already occupy then it is no longer considered encroachment. Plain and simple.

So how are relationships built? Relationships usually take time and are built through trust, honesty, communication, a common goal, a purpose from which both parties benefit and so on. How are relationships destroyed? In real life if a true relationship exists it really is harder to destroy a relationship than most believe. Unfortunately too often we have casual "relationships" with acquaintances which can be in both business and in our personal life. This casual "relationships" are from what most of us draw experience on "relationships" and on which we base most of our decisions. If an actual relationship existed, one that was formed on the trust, honesty, communication, a common purpose or goal as mentioned previously, a little thing like misinformation would not ruin the relationship so easily. In casual relationships one piece of gossip or he said she said is often enough to break ties for good. I am sure we have all had this happen before. We hear from a friend that another person we thought was a friend was talking about us behind our back? (Remember this in high school?) How many of us still talk to those people? My guess is that if it was a true relationship that unless distance and/or life crept in we are still talking to those people, if not thinking kind thoughts about them.

So why did I use the term professional encroachment in regards to the NATA lawsuit against the APTA? When you look at the relationship that has been between the NATA and the APTA it has been one viewed from all parties as confrontational. The APTA is not willing to stand side by side if the NATA is looking to move into space that the APTA feels their members are already in. If Athletic Trainers (as their name implies) wanted to just work with sports teams and stand on sidelines  and in the training room doing the excellent job they are trained to do then the APTA would never have had an issue with this.  The job like  physical therapy evolved from a need. The athletic trainer was needed to help athletes. The athletic trainer is highly educated in their field. But where does their field start and the physical therapist field stop? That is the million (or couple million dollar question) at hand.

There is a gym in town that offers "Functional Therapy" for active people. It is owned and staffed by athletic trainers who are strength and conditioning specialists as well. They tell me that they are more than educated to provide treatment to active people of all ages and not just those that consider themselves athletes. Unfortunately what they don't tell people is that they are athletic trainers. "Functional Therapy" sounds better I guess. I have had at least 5 people come up to me and tell me that the therapist at that gym implied they did physical therapy and actually all thought these guys were physical therapists.

So the NATA wants its members to be able to provide "incident to" therapy services with Medicare (note not "incident to athletic training services") and expects the APTA to stand by and let professionals with dual licensure teach others with only one license (ATC) certain treatments. Am I wrong?

My question is why are they not fighting so hard to tell the public that Athletic trainers do athletic training and that includes a lot of the same things that physical therapists do and exercise physiologists and personal trainers and so on? My guess is that on its own without legislature, they would not have a basis for this.  My understanding and maybe I am wrong, is that if you want to do something you go get the appropriate degree for it. Those dual licensed PT/ATC individuals didn't start a lawsuit to avoid having to go back to get another degree. They chose to go get another degree and paid their dues. I bet those individuals would be pretty peeved if they were told they didn't have to go back to school and were now able to do what both degrees allowed them to do before without the degree. As for all of these examples of people with their ATC and exercise physiology degree another example of what I am talking about. Same person went back to school for two different degrees. Any person that claims that their physiology was different is ignorant and anyone that claims that CPT codes stand for Physical Therapy codes is severely misinformed. Take it for what it is, blame the person not the profession. Professional Encroachment is taking something that someone else is already doing and trying to do the same thing. How would you feel if you got pushed?

Comments

[Rob]

I fully agree that one professional organization should not be legally allowed to influence the development of another profession. When you say "if you want to be a captain, go to captain school", that bothers me. I witness PT Clinics who advertise Sports Physical Therapy and Sports Medicine all the time. When in reality its nothing more than a marketing ploy. Sports Medicine is a team approach to the care of athletes. It consists of physicians, specialists, physical therapists, athletic trainers,coaches, etc. You cannot imply that only one link of the chain can perform Sports Medicine. Now, to be fair, there are certain physicians that have Sports Medicine included in their name, so there is not just one culprit here.

So from what I've gathered here on this forum, I guess PT's opinion is that ATCs are the only one's who should provide "Sports Physical Therapy"? I in fact know that PT's are going to jump all over that point. Bottom line is that if PT's want ATC's to be limited to athletics than PT's should not be allowed in athletics! So how do PT's feel when I say this? I'm very, very sure that they would not agree, and sure that that would severely anger those individuals. That's my point, no ATC is ever going to take that kind of stand. Yet PT's make that point almost everyday.

By allowing this lawsuit to proceed the courts must have enough evidence to prove that these infractions have indeed occurred. While PT's are educated in rehabilitation alone, ATC's have much of the same knowledge as a PT and are trained in many of the same techniques, in addition to a body of knowledge that does NOT come from PT school. So why shouldn't they be allowed to perform the duties they are trained for and be reimbursed for their services? After all, if PT's want a piece of the ATC's pie, they should stop acting like scorned children and share what they have as well.

The point of this post is to make everyone "think" about what they are saying and how it effects others. All the time, attitudes and opinions like some of those presented here bring us farther and farther apart professionally.

And for the record, my official stance is neutral in this matter. I see the benefits of both professions.

Thank you

[Brian Boyle]

Isiah,

I hear you. I don't think any health care provider should be able to say what another health care provider can do either. Have you ever heard of chiropractors fighting PT's on the right to perform manipulation? Sounds a lot like the NATA claim about the APTA, hum? In North Carolina I can perform spinal manipulation only once I call the physician who then has to write an order for me to do what I am trained to do. If ATC's think they are the only ones ever having to face this issue, they are are sorely mistaken. Sounds like a generation gap to me. Kids always think they are going through issues that no one else has ever had to face.

"Don't wish it was easier, wish you were better" is an old saying that a colleague of mine likes to say. I don't wait for the APTA to market for me. I am an active member of 6 organizations in and around the local community and actively market on TV and in print. If I waited for the APTA to market my services I would be hungry (and out of business). Also in NC we have direct access so I can see clients who have never seen a physician for their current condition. If it is out of my scope of practice I refer it on to the appropriate physician.

My guess is that the issue with Medicare "incident to" billing services for physical therapy is not an issue you think the NATA should be fighting for then? You say you never wanted to be a PT? Seems to me that the NATA would disagree. Last I checked there were a lot less senior "athletes" being seen in physician offices, but a lot more ATC's working under the direct "supervision" of MD's in the offices seeing older adults for treatment. Also I know a lot of ATC's that do FCE's and job analysis. Last I checked the NATA didn't just believe that athletes were the only people ATC's treated.

And lastly I would love to see these letters that the APTA is "passing around" to all of its members. I am active in the APTA on a local and state level in NC and I have never seen any of these papers. "The letter" in reference was one persons opinion based on guidelines set forth by the APTA (which by the way less than half of all licensed PT's are members in the APTA.). The APTA is not the law and does not have the power to force anyone to do anything. They have lobby groups like everyone else and will fight for its best interests, but that doesn't mean that what is right for us is right for everyone. My guess is that there are probably more PT's that have contact with the public that are not members in the APTA and they cause more of the issues of ignorance and misinformation than anyone else.

Thanks for the post.

[Isiah ATC]

Hold up,
I do not want to be a physical therapist. I have no desire to treat stroke, neurological disorders, pediatric disorders, and other disorders which are in the scope of practice for a PT. That is not in my scope of practice and that is why I do not want to go to PT school. Plain and Simple another health professional can not determine what another health care practitioner can do, that is up to the health department and the legislature to determine. I like working with athletes and that is what the law allows me to do. But if another organization is saying that I should not be doing what I am allowed to do that is liable. If it is taking money out of my pocket I have a right to seek legal action.
Frankly I use my own manual therapy techniques and none of them I learned from a PT, it is marketing to the public that I am not qualified to do something when a PT is not the person who makes that decision.

[Isiah ATC]

Hey,

I am a florida licensed athletic trainer. I have been reimbursed from insurance companies for my rehabiliative services under the protocol of a licensed physician. By law, which is what matters the most, I can do this on the sideline, in the training room, or in my clinic (Athletic Training Clinic, not Physical Therapy Clinic.) I do not need to call myself anything but a Licensed Athletic Trainer. But here is the problem. Physical Therapists did not create Manual Therapy. It is a term used by many health care professionals in rehabilitative medcine, PT, ATC, Chiros, Osteos, and Massage Therapists. The Physical Medicine Codes do not say Physical Therapy Codes. So it comes down to this. Is the APTA discouraging the enhancement of another profession so that it can not be infringed on financially (forming a monopoly)? For example, the NFL did not create football, so it can not go around telling everyone that the Canadian Football league is a secondary league and no one should attend their games that would break their anti-trust exemption. So if the APTA (read the letter at nata.org) is encouraging its members or telling the public that Athletic Trainers are not adequate enough to practice manual therapy then that is anti-trust. It is up to each individual patient and that patien's physician to decide what is best for them as long as they are working with some one within their scope of practice "by law". Remember athletes need manual therapy just as much as the regular population. Does taping belong to AT's? Does Spine Injury Management or Emergency Care just Belong to AT's? But you see PT's doing it all the time, large part because they have learned this from principles and research done by ATCs.

[Jason Harris]

Great post. As you've heard me say before, 'if you want to be a captain, go to captain school'. Don't become and ATC, wish you were a PT, and sue, and back into treating as if you were a PT.

As I posted on my blog (http://realpt.blogspot.com) the NATA "Fact Sheet" all but states "we are just like physical therapists and should be treated as so". They aren't even fighting to expand in the setting(s) they started in, but are trying to shame/sue/confuse their way into the well established, legislated, and trained areas of PT's. Plain and simple. This has nothing to do with the APTA "bullying" the NATA. It has everything to do with the NATA wanting what the APTA has without going out and getting the education for it.

Check out the NATA "Fact Sheet" here: http://www.nata.org/consumer/docs/Factsaboutathletictrainers.pdf

In this case "Fact" is used loosely.