Professional Encroachment?

The term "physical therapy" is unique. Depending on what side of the fence you sit on, those who are physical therapists/therapist assistants and those who are not, will determine how you define the term. Those members of the public outside of the profession I am sure would enjoy it if the public referred to physical therapy as a junk term that could be used by anybody performing any "physical  therapeutic service or treatment to the human body." Unfortunately for those select individuals and groups it is not.

The National Athletic Training Association (NATA) recently filed a lawsuit against the American Physical Therapy Association (APTA) stating that remarks that were the opinions of APTA members, amounted to nothing more than collusion and violated anti-trust laws. Basically from what it appears is that the NATA is looking to advance its scope of practice and believes that physical therapy in general stands in its way. Specifically the term "manual therapy" comes into question. The NATA believes that the APTA is standing in the way of educators teaching athletic trainers these techniques.

Unfortunately I believe that this is all born out of frustration and is an unfounded accusatory lawsuit that is not based in merit. I was told by the athletic trainer at my high school as I was choosing a career that if I wanted to work with athletes, work long hours, for little pay then this was the career for me. However, he added that if I also liked the rehabilitation portion that I should become a physical therapist. He correctly pointed out that I would have more career opportunity paths to choose from in the physical therapy profession than I would as an athletic trainer. If athletic trainers feel that they are unfairly restricted from practicing in other areas of health care then just working with (as the name would imply) athletes, then perhaps  those individuals should not go into athletic training and/or should go back and get another degree. Now one take on this could be that the athletic trainer had no vision and did not see the potential for where his profession could eventually take him. Or more correctly he realized the scope of his practice was to work with athletes to return them to competition or sport (again as the name itself implies).

Market conditions in general should be able to decide how such things are played out. Marketing doesn't have to convince people of the facts, it just has to be able to convince people to use or buy. If a person wanted to seek treatment for an athletic injury it would seem that they would call an athletic trainer. If they wanted to seek treatment for another injury they would go to a physical therapist. If the athletic trainer was good at what he/she did then the public would continue to come. If the trainer was not good at what they did or could not convince others at least that they knew what they were doing then their practice would not survive. Simple as that, unless they implied that they were something that they were not. To bring a frivolous lawsuit against the APTA because the NATA feels that they are being unfairly treated is just a waste of resources and a stumbling block at building relationships that could be mutually beneficial.  It seems that the NATA would rather try to force something (easy route) rather than doing the leg work to get the public to try to believe that they are highly skilled professionals that do serve a purpose in health care (harder route, but more responsible and adds more credibility to the profession).

It will be interesting to see if this backfires in the face of the NATA. As it would appear exercise physiologists, physical education professionals, and personal trainers all could be fighting athletic trainers for their slice of the proverbial pie. If the NATA were to win, I think it would open up lawsuits from these other professional groups looking to sue the NATA for attempting to keep them out of the "playing field," pun intended of course.

Comments

[Brian Boyle]

Heaven,

There is a lot of information from both sides of this (chiropractic versus physical therapy). A Google search with the key phrase above will give you plenty of reading material.

The key issues are which profession, if any, "owns" spinal manipulation? Which profession "owns" modalities (Therapeutic Ultrasound, Electrical Stimulation, Ice/Heat, etc.)? Who has the best knowledge in these areas and who is the practitioner of choice. Also many in the public still unfortunately believe they need to see a physician to get a physical therapy order, but can go see a chiropractor without an order from a physician. With direct access in most states, the public can not only see a physical therapist they are covered by their insurance to see the physical therapist and are often only liable for their copay or deductible.

Many people unfortunately mislabel manipulation as what chiropractors do and modalities as "physical therapy modalities" and believe that is all that physical therapists do. We still get physicians prescribing "US, Heat, and Massage" for their patients with neck and/or low back pain. None of which have been proven to be effective for low back/neck pain alone and most insurance companies won't even reimburse for their use in patients with pain in these regions.

This post has stirred a lot of controversy and it was meant to provide a talking point and a start for debate. I know a chiropractor who also has a Masters Degree in Exercise Science. He is well trained in spinal manipulation, prescribes exercises to his clients, performs soft tissue release techniques, uses modalities, and can even take X-rays. Other than performing X-rays he sounds an awful lot like myself. Where does the line get drawn for what is Chiropractic versus Physical Therapy versus Exercise Science and so on? With individuals like him he chose to get an advanced degree in Exercise Science. So that is probably where the line ends. He no longer falls under strictly a Chiropractor he also has advanced degrees in other areas which make him an expert in those fields as well. My whole point is get the advanced degree, the certification from an accredited institute/organization or whatever it takes to prove that you deserve the expert status. Don't assume that because you have seen others do something and you mimic their actions that you are also of the same status.

I just recently interviewed a gentleman who had a Masters Degree in Exercise Physiology. There is no license for Exercise Physiology so they are not licensed individuals (more on that point in a second) and definitely not health care professionals. They are individuals with degrees and in this particular case he was an individual with an advanced degree. A license holds someone accountable and threatening to take someone's license away usually holds more meaning especially if they could lose their livelihood. An unlicensed individual may face civil and criminal action, however it would not always effect their professional well being.

This particular person informed me that he works with a large organization and that he has been trained by Chiropractors and Doctors of Physical Therapy in advanced techniques to take care of injured athletes. He now goes all over the country providing medical care for camps and clinics and is the director of medical care for one camp in particular. This is scary! He is not licensed in any state, has no boundaries for where he can go, and has no desire to go ahead and get any other degree in a healthcare related field because he feels he has been trained and already knows what he is doing. A person like this "mimics" and does not "diagnose and treat." It would be like saying anyone that changes their own oil is a mechanic. Unfortunately a little knowledge can sometimes be a dangerous thing.

I hope this is what you were looking for.

Brian

[Heaven Smith]

Dr.
would you please give me more info. on the Chiropractors and this issue?

[B_Rad]

You obviously do not understand or respect the athletic training profession enough to make any comment on it. Stating that all exercise physiologists,personal trainers, and physical education professionals would have to do is add a couple athletic training classes into their curriculum and that would qualify them to practice athletic training is completely radiculous. You and many physical therapists have no respect for the athletic training profession. I got news for you, there is not another profession out there that has the full package to prevent, respond to, and treat an injury caused from physical activity as effictively as a certified athletic trainer can. Bottom line. Oh, and I work in the industrial setting and the injuries within my company are the same injuries I see in sports. I treat them exactly the same as I would an athlete. So while physical therapists are taking there sweet time being conservative with their rehab, we are more trained in taking an aggressive approach getting the employee back quicker. An exception would be a PT with ATC credentials that has experience in the athletic setting. If ATC's recieved 3rd party reimbursement PT's would loose a lot of buisness. Too bad the PT's have more funds to pay off politicians to keep that from happening. ATC's are more threatening to the APTA then Chiropractors are.

[Brian Boyle]

Bryan,

Thanks for your comments. I am glad you are willing to defend your position and I don't believe that my post was dismissive as much as it was to highlight what some refer to as "professional encroachment." I am always of the mindset that we must reap what we sow. If the NATA wants to open a lawsuit against the APTA then so be it. But have they thought about the ramifications it could have with the personal trainers, exercise physiologists, and physical education professionals? I would argue, they, like PT's and ATC's feel that they also work with "active" people. Many exercise physiologists are educated at PhD level and all they would need to do is open up university curriculum to add some on-field medicine and emergency care and now what do we have an even more educated Athletic Trainer?

If anything the APTA has enough to defend itself against with Chiropractors attempting to limit manipulation and with Physicians owning Physical Therapy clinics. I could lament on these issues as others trying to hold down the APTA and physical therapists. ATC's would do better to push for direct access and get out from under other providers than they would to push a frivolous lawsuit against the APTA. But that is just my opinion and that and $3.50 will get you a cup of coffee at Starbucks.

Thanks for reading and best regards. I like dialog!

[Bryan Schendlinger]

Dr. Boyle,

Your rather dismissive blog in regards to the recent lawsuit filed by the NATA highlights the underlying issues which prompted the NATA to take action.

Your attitude that this whole situation is about the NATA wanting to expand their scope of practice and that we feel bottled in because of our decisions to work with "athletes" only is severely misplaced. On that point, we do not just work on "athletes" but anyone who falls under our scope of practice. The NATA wants the APTA to allow Certified Athletic Trainers to provide service under that scope of practice, not conduct themselves in a manner that hinders the market from making the choice themselves.

I will have to agree that the APTA may not be officially writing down policies for its members to follow regarding these tactics. The fact that they are allowing these actions and mindsets to flourish among the PT profession is where they have committed the offense. Since you refer to your conversation regarding the AT profession from school, I will refer to my experience with PT thoughts on the AT profession. On one instance I heard a PT student in college tell a friend that her input on a physiology question wasn't appropriate because "you've only taken Physiology not Physical Therapy Physiology". I will point out that though my friend wasn't a PT, she did have a MS in AT and a PhD in Exercise Physiology. I have also on occasion heard practicing PTs refer to CPT codes as Current Physical Therapy codes which is one of the specific complaints in the NATA lawsuit. The actions and knowledge of its members and students is a reflection of the APTA organization. It's the lack of initiative of the APTA to change philosophies that result in those kinds of mindsets that the NATA is trying to combat with this lawsuit.

We are educated and licensed just as Physical Therapists are. We conduct ourselves under the scope of our training to the utmost ethical standards. All we want is for the APTA to stop acting like the monopoly and dictator it is in the "Physical Medicine" realm and allow that Market to choose or not choose who to receive that care from.

I'll gladly respond in turn should you feel compelled to post this.

Sincerely,
Bryan Schendlinger, ATC