Models Of Practice, Physical Therapist Autonomy, And The Meaning Of Life

The American Physical Therapy Association’s Annual Conference is this week. The House of Delegates has a number of hot topics on its agenda today and tomorrow, most notably discussion regarding “Physical Therapist Responsibility and Accountability for the Delivery of Care”. In many other circles, this would be shortened to “professional autonomy”, but it wouldn’t be governance without a long-winded title now would it?

Fortunately, this upcoming discussion has fueled its share of blog posts (great sample here, with some added history lessons here), along with a number of enlightening Twitter discussions (transcripts here and here).

It has been a week since I posted “Vision Now: A Physical Therapist Manifesto”. In the meantime, I continue to be bewildered by some of these discussions. Are physical therapists really ready to own their profession? Or are they spending too much time pondering the meaning of life while health care reform rolls on?

I like to keep things simple.

Autonomous physical therapists will have behaviors consistent with "independent, self-determined, professional judgment and action" – one of the good things to emerge from Vision 2020. Autonomy is the underlying mechanism for all others – direct access, delegation, reimbursement, you name it.

Physical therapists define physical therapy. They are the ONLY practitioners that do so. Period.

The autonomous physical therapist will ultimately be responsible for a plan of care from a medico-legal perspective, regardless of who it is being delegated to. There is also a Code of Ethics that provides an overview of what is appropriate and what is not. Add to that the state licensing acts, and I think we have plenty of “checks and balances” to make sure that the profession heads in the right direction.

But these discussions invariably promote a lot of fear mongering. Will this “dilute the profession”? Will physical therapist assistants lose their jobs? Will physical therapists simply delegate tasks to anyone, lowering the cost and increasing their net income?

The answer is: NO. Here’s why -

- Physical therapist assistants have and will always be working under a physical therapist’s plan of care. That is simply by definition. If physical therapist assistants continue to provide good value clinically – and as a PTA educator, I have no doubt that this will continue to happen – then nothing will change. They will inherently provide great value in many practice settings, and will continue to be gainfully employed.

- As for the idea that physical therapists will simply delegate to anyone – well, they have a practice act and a Code of Ethics to contend with on that one. Call them out on it if it concerns you so much. Oh, and besides, there is that little thing called medico-legal responsibility.

Everyone can breathe now - the world isn’t about to end.

Were physicians up in arms and in a tizzy when physician assistants came on the scene? Were they worried about their autonomy or delegation responsibilities? Did physician assistants ever think there was an issue? How about chiropractors and chiropractic assistants? I think you know the answers.

What dilutes the profession right now are physical therapists that are unwilling or afraid to have behaviors consistent with autonomous practice, thereby holding back the advancement of the profession as a whole.

Our profession is stuck sitting on a fence, immersed in the paralysis of analysis, trying to bring meaning to what may become a crippling identity crisis. Of greatest concern is that it is 2012 and we are debating this at all. Meanwhile, health care reform is moving along and here we are sitting in a circle pondering the meaning of life. But if the APTA and its members want to fiddle while Rome burns, then so be it. Just remember, I don’t play the fiddle.

If we are going to have vaunted goals similar to other peers (i.e physicians, chiropractors, etc), we need to behave like them. That starts with autonomy. We need to stop worrying about this petty stuff and get down to the stuff that really matters – having full professional autonomy and direct access in a (gatekeeper-free) free market economy. Right now, we are at 17 states. It needs to be 50, and we can’t accept no for an answer from any other stakeholders but ourselves.

When we take ownership of this issue, and truly get on with it, we will no longer be considered to be an ancillary provider. But we have to believe it, and we have to live it. And if you aren’t ready to step up and own this, no worries – but please, get out of the way of those who will. It will benefit us all.

I would urge you to follow the hashtag #solvept on Twitter and get involved on whatever level you can. Be the change.

Photo credits: Vironevaeh