Mobilize Your Autonomy

There are many issues in which the perceived problem isn’t really the same as the mechanism underlying the issue. Oftentimes it will require peeling away a few layers of the onion to get to the core issue at stake. Joint mobilization – be it performed by a physical therapist or physical therapist assistant – illustrates one of these issues.

As I mentioned in my previous post, “Joint Mobilization And The PTA: Much Ado Over Nothing?”, there are plenty of reasons to indicate that PTAs are, or certainly have the capacity to be, qualified to perform joint mobilization. Let’s face it - patients take their joints to end range daily, oftentimes with sustained loading and frequently with greater maximal end range loading than a PT or PTA will ever utilize. So why be concerned about the PTA?

With that said, there is an emotional debate brewing. Why? Time to peel away a few layers of the onion to find the source. Unfortunately, while debating the minutiae of kinematics, educational degrees, and manual skills, the critical importance of autonomy is overlooked – to the detriment of the profession as a whole.

If you take this debate for face value, then it starts to look like a within-profession turf battle that is utterly senseless. And you would be correct in stating that.

But the issue isn’t really about mobilization. That’s a symptom. The issue is with the true meaning of professional autonomy – and having behaviors consistent with it.

A physical therapist is responsible for the clinical care of the patient, and must act in accordance with this, regardless of the chosen extender of care. The physical therapist has the decision-making capacity, and they must utilize it effectively, responsibly, and judiciously. Autonomous practitioners understand the importance of this role.

But won’t extenders of care dilute the quality of care? As an autonomous practitioner, you must decide the quality and standards of care that you desire for your patients. As a physical therapist, this should be consistent with the APTA Code of Ethics and how it establishes professional boundaries and behaviors. If you don’t wish to use an extender, then DON’T. That is your prerogative. Nobody is being forced to use one. At the other extreme, if a physical therapist chooses to accept responsibility for a poorly-trained extender that is performing treatment interventions because it is cheaper to do so and provides a higher return on investment, then so be it.

Don’t worry – this “problem” will eventually self-regulate. Either the Code of Ethics catches up with the clinician, or the medico-legal system will. If neither of those does, then patients will acknowledge the differences in the quality and value of care provided. Oh, and if THAT doesn’t regulate the problem, then sooner or later third party payers will define reimbursement based on quality and outcome.

I think in government they call this “checks and balances”.

Here’s a novel idea. How about we continue to refine PTA education so that there is no question whatsoever that the PTA is the extender of choice? In the meantime, how about PTs embracing the true meaning and responsibility of autonomy and making sound decisions about their extenders of care (if any)?

If we don’t proactively define our autonomy, then we will be defined by someone else. While the intellectual debates persist, the profession will be swallowed up by groups having far more political clout, consumer savvy, and marketing prowess than we have.

The time is now to “mobilize your autonomy”. Take responsibility and promote true signs of professional autonomy. Make decisions that impact the quality of care of your patients, and not just decisions based on the cost of care. Find better business models that allow you to make money while enhancing quality of care.

But don’t look at your peers and have the gall to say that the PTA isn’t capable or qualified. Perhaps the bigger problem is the physical therapist that is lacking the behaviors consistent with autonomous professional practice in the first place.

Photo credits: Y F Photos