Extreme Makeover: Physical Therapist Edition

[Note: This post is not in any way affiliated with ABC nor any of its associated television programs.]

The physical therapy profession is standing at a crossroads.

There is no doubt in my mind that physical therapists are the international experts in therapeutic exercise prescription. Physical therapists are the international leaders in non-surgical care for musculoskeletal conditions. There is now plenty of data to support that evidence-based physical therapy saves money while optimizing function.

But I would suggest that physical therapy in the United States is in need of an Extreme Makeover. And as soon as possible. Why?

It all starts with how we view ourselves.

Here is but one example. At last week’s APTA Annual Conference, there was significant debate over “physical therapist responsibility and accountability for the delivery of care”. In simpler terms, “professional autonomy”.

To me, it is a bit of a no-brainer for the APTA to state that it

“… recognizes that physical therapy is provided by, or under the direction and supervision of, a physical therapist. Evaluation remains the complete responsibility of the physical therapist”.

Duh. How this is being debated in 2012 – especially now that Vision 2020 has been in place for 12 years – I will never understand. Better yet, let’s wait until 2014 to establish new models of practice. What? I can assure you that physicians and chiropractors, our peers in the health care marketplace, didn’t go through all of this in their professional development.

While physical therapists are trying to figure out who they are, how they do what they do, who they delegate to, why they do so, when they will do so, and repeatedly trying to prove what they do to stakeholders who aren’t listening and never will, the rest of the health care world stands, laughs, and moves onward without us, and with their own hidden agendas at full throttle.

I am convinced that the easiest and perhaps most lucrative job in the world has to be the lobbyist that works for any gatekeeper association that opposes physical therapists. Why? Because they don’t have to do much. Physical therapists seem to be too busy looking for the meaning of life, stuck in the paralysis of analysis.

Much of the problem of our profession lies within ourselves. The profession has created its own issues and has continued to perpetuate them behaviorally. For example:

1. When you believe you are subservient to other health care providers, you are.

2. When you believe you are an ancillary provider, you are.

3. When you do what you’ve done, you will get what you’ve got. Insanity, as they say, is doing the same thing twice and expecting different results. Sounds like direct access legislation to me.

4. When you are overjoyed to have “limited direct access”, you are accepting external stakeholders throwing you a bone of appeasement until the next legislative session when you will, once again, have to defend what you do to keep what you’ve “attained”.

5. When you continue to turn a blind eye to chiropractors or other health care professionals providing “physical therapy”, you will continue to be tread on mercilessly. Repeat after me: physical therapy is performed by physical therapists.

6. POPTS, or Physician-Owned Physical Therapy Services, are, simply put, yet another conflict of interest in a health care system full of them. This is no different than the income stream afforded by owning an imaging facility or a laboratory service. Let’s not promote over-utilization, please.

7. For those physical therapists who are concerned about the responsibilities of autonomous practice, you might want to consider this: you are already doing so because your professional responsibilities are wired into your practice act. If you don’t want to see patients via self referral, nobody is forcing you to do so.

Perhaps worst of all, if we as physical therapists don’t truly believe in what we do, or who we are, how can anyone else – consumer, legislator, or other stakeholder – ever believe in what we do or say?

In the movie “Network”, Howard Beale noted

'I'M AS MAD AS HELL, AND I'M NOT GOING TO TAKE THIS ANYMORE!' I want you to get up right now, sit up, go to your windows, open them and stick your head out and yell - 'I'm as mad as hell and I'm not going to take this anymore!' Things have got to change. But first, you've gotta get mad!... You've got to say, 'I'm as mad as hell, and I'm not going to take this anymore!' Then we'll figure out what to do about the depression and the inflation and the oil crisis. But first get up out of your chairs, open the window, stick your head out, and yell, and say it: "I'M AS MAD AS HELL, AND I'M NOT GOING TO TAKE THIS ANYMORE!"

There is no better time for an Extreme Makeover. We, as a profession, need to take a far more vigilant stance on these and many other issues nationally. This needs to be direct and disruptive. It starts with each and every physical therapist taking ownership. It may involve a self image intervention, a significant adjustment of belief systems, to get it done. But it can be done, one person at a time, challenging their own belief systems and raising their comfort zone.

I call on each and every one of my peers in this great profession to do what is right – versus doing what is right now.

The self image intervention starts with “Vision Now: A Physical Therapist Manifesto”. Take a personal oath of action to practice and behave consistent with independent, self-determined, professional judgment and action. Don’t just talk about being an autonomous professional. Foster behaviors of it on a daily basis.

Don’t seek permission when it comes to your skills in the health care community. Work within the limitations imposed by your state practice act, but move forward with and promote actions that support a true free market, one free of gatekeepers and legalized monopolies. Your patients – and your peers – will appreciate it.

Become a member of the APTA – and hold the leadership accountable. I do believe in the value of professional association membership; however, I do reserve the right to retract this statement if our association continues to avoid the mechanisms underlying our issues and drags their feet on them as well. Leadership needs to be held accountable in all aspects, and we all need to be involved in this, self included.

Get involved with groups like the PTBA, or the P1 Project. Get onto social media and #solvePT. Be the change. Daily.

If this underlying behavioral mechanism isn’t addressed, then we should expect to remain as what amounts to an ancillary provider in the vast majority of states in the union.

Remember – in the words of Alexander Hamilton -

“If you don’t stand for something, you will fall for anything.”

Physical therapists should be taking center stage in health care reform. But that isn’t going to come easily, and what is rightfully ours will not come without courage, without ownership, without an Extreme Makeover, and without a fight or two along the way.

Photo credits: Rob Mattheu