Healthcare workers have gotten some extra love since the pandemic started. More people now than ever seem to grasp the dedication, expertise, compassion, and selflessness required to be a healthcare provider. So, why are physical therapists not part of the love fest?
It seems as though even other healthcare providers don’t quite understand the significance a DPT, doctor of physical therapy, warrants within healthcare. They are DOCTORS of physical therapy, yet they are not recognized for their expertise in movement and treating musculoskeletal conditions.
A Little Physical Therapy History
Physical therapy as a profession in the United States developed due to the demands that stemmed from two significant historical events, WW1 and the Polio epidemic. PTs were first known as Reconstruction Aides and mainly worked in hospitals.
By the mid-forties, legislation was passed (the Hill-Burton Act) to increase the number of physical therapists due to the rising needs of surviving soldiers and polio patients. Then in the fifties, therapists progressed to more specialized practitioners in addition to more legislation being passed that broadened physical therapy treatment outside of hospitals to outpatient services.
Through the sixties and into the seventies, practice acts expanded in more states, and therapists that had mainly treated orthopedic disorders, illness recovery, and war wounds expanded the treatment of neurological conditions and chest physical therapy.
As time progressed, medicine advanced and so did the PT scope of practice, more legislation was enacted to care for disabled children in schools, and injured workers protected by OSHA. Now specialties such as women’s health and oncology are just two of ten specialty certifications offered by PTs and recognized by the American Physical Therapy Association (APTA).
Physical therapy required a Bachelor of Science Degree initially (1961), then a Master’s Degree (MPT) until the late nineties, and eventually by 2005 the curriculum changed in all universities, and the Doctorate program (DPT) became the standard in present-day 2023.
What Does a Doctor of Physical Therapy Learn in School?
Let’s talk about the DPT program curriculum to get a better idea of the education and training involved and how therapists become experts in physical movement and rehabilitation.
As one of the top DPT programs in the United States, the University of Southern California (USC) boasts of being the first DPT graduating class (1996). USC is known for its research capabilities and proximity to innovative prestigious medical centers, which benefits students greatly on their journey to become therapists.
Here is a sample of coursework packed into the three-year DPT program:
Cellular and Systems Physiology
Evidence for Physical Therapist Practice
Musculoskeletal Anatomy
Basics of Patient Management
Mechanics of Human Gait (Movement Analysis I)
Clinical Imaging
Therapeutic Exercise
Analytical Anatomy
Evidence for Physical Therapist Practice
Disorders of the Musculoskeletal System
Clinical Biomechanics (Movement Analysis II)
Clinical Management of The Patient with Musculoskeletal Dysfunction
2-Week Clinical Experience1
That’s just year one. The second year includes a summer semester and is just as intense containing medical conditions and disease management courses. While the third year is mainly focused on clinical hands-on learning along with the last few classes including evidence-based research and practice, and (certainly not least) differential diagnosis.
DPT programs across the United States that are accredited by the Commission on Education in Physical Therapy Education (CAPTE) are required to contain certain educational criteria to remain accredited:
“Maintains a cadre of approximately 300 volunteers who are trained to conduct on-site reviews of physical therapy programs;
Conducts on-site visits to approximately 80 programs annually;
Reviews information from approximately one-third of all accredited programs at each meeting”
Why are these technical items important? Because it establishes the basis for DPT standards of education.
First, you must graduate from a CAPTE-accredited DPT program to then be allowed to take the National Physical Therapy Exam (NPTE), governed by the Federation of State Boards of Physical Therapy (FSBPT), which you are required to pass to finally receive a Doctor of Physical Therapy license in the state which you applied.
There’s a lot of alphabet soup there, but the gist of it all is that it requires significant and regulated education, training, and aptitude to accomplish a DPT Degree and licensure.
After all that, what do they actually do when practicing?
Doctor of Physical Therapy Scope of Practice
The American Physical Therapy Association (APTA) defines the PT scope of practice as follows: “The scope of practice for physical therapists has three components: professional, jurisdictional, and personal.”
The profession is based on the professional education, knowledge, and evidence required to practice, that is the structure of the profession itself.
The jurisdictional refers to each state’s practice act and laws that govern a therapist’s practice.
The personal aspect means the education, training, and competency of the therapist to perform their job.
The PT scope of practice is similar when compared to a medical doctor (MD) or nurse in that it refers to the education and training to competently practice medicine within the boundaries of their license. Each state has a practice act that specifies regulations for PT treatment. The scope of practice is always evolving to include the newest technology and ideas derived from evidence-based research.
With Higher Education and New Laws Comes Great Responsibility
Please pardon my twist on a pop culture reference (Uncle Ben, “Spiderman”), but the progression of “Direct Access” spurred the physical therapy profession into the doctorate realm to ensure their skills were up-to-task to provide primary treatment.
Direct Access (DA) removes the state mandate that a medical doctor referral is required for PT evaluation and treatment. DA allows a patient to begin physical therapy services (self-referral) without an order from another healthcare provider which streamlines the process and improves access to patients starting care sooner. Earlier intervention results in better treatment outcomes.
Direct Access to PT is now available in all fifty states, however, there are continued regulations that limit it from state to state. Health insurance companies in some states still require a physician referral to continue treatment once an evaluation has been performed. Medicare has such a regulation, yet again, it is dependent on that state’s practice act.
Interestingly, The United States military has been utilizing PTs as primary providers for decades and this is now well documented.
“Since the early 1970s, Army physical therapists have successfully served as nonphysician health care providers or in a physician-extender role when performing primary care (ie, evaluation and treatment for patients with neuromusculoskeletal conditions).”
The APTA authored and adopted a vision statement in 2000, “Vision 2020”, with a strategic purpose to further the profession of physical therapy with direct access being one of six key points. The plans have been laid out to improve the professional level and autonomy of DPTs and they have answered the call.
Research shows that DA not only improves access to healthcare but also decreases the cost by taking out the “middle man”. A forty-month study based on a large sample of the military (US Army) patients (over 57,000) were assessed by Physical Therapists with no adverse occurrences recorded. Additionally, regarding evaluation and management by a PT for musculoskeletal disorders:
“the evaluation capacity and the competences required to physical therapist managing MSD compared to medical doctors’ expertise and skills: interestingly, results showed that expert physical therapists specialized in musculoskeletal disorders possessed better skills and knowledge for MSD assessment compared to most medical specialists except for orthopedic surgeons.”
Now, before the MDs come after the author or physical therapy in general, no one is saying stop going to their primary care or family doctor for medical care. The purpose of this piece is to shine a light on physical therapy as a specialty in musculoskeletal disorders (MSD) and to inform DPTs can be primary providers of such issues instead of seeing their MD/PCP first.
The Pandemic Made Physical Therapy “Essential”
If you recall, during the Covid-19 pandemic medical professionals other than doctors were deemed “essential”. They were anointed front-line workers and mandated to continue to see and treat patients in person throughout the pandemic. Much like the Army deemed PTs necessary as primary care providers during the Vietnam War.
Needs determine who is essential, but once again, PTs stepped up when asked and delivered quality, competent care. Since Covid has become endemic and we have a new normal, physical therapy seems to have been demoted from a first-line healthcare provider to the “trainers” many think they are.
Physical therapy should be thought of first and foremost when any muscle, joint, bone, or nerve condition arises. Instead, it is often a last-ditch effort to treat a patient when their doctor is out of ideas. DPTs are MSK specialists who have been educated and trained to diagnose and treat musculoskeletal disorders.
In Summary
DPTs recognize their boundaries and can differentiate if their skills will help a patient recover or if another intervention is required. They acknowledge other healthcare professionals and their expertise and would appreciate the same respect in return. Healthcare must decide once and for all if physical therapy is an essential part of healthcare or a secondary service provider.
Doctors of Physical Therapy are professionals, capable of being primary musculoskeletal care providers. They have the training, and the tools, and execute them with competence and care. DPTs as first-line providers improve patient access to care and provide effective treatment which results in lower overall cost of care. Based on numerous studies direct access has been successful even with continued limitations by state and insurance.
Finally, it’s time for the healthcare industry to show some love to physical therapy and DPTs alike. They’ve been disregarded as specialists for too long despite meeting every marker set for their profession and proving their expertise through every challenge the healthcare system demands of them.
