From AAOMPT official
newsletter: Articulations
July 2005
Practice Affairs Corner
William Boissonnault, Academy Practice Committee
Chair
Who’s Judging Whom?
The Challenge From Chiropractors
Although not as
frequent as 6 to 8 years ago, Physical Therapy (PT) Association State
Chapters continue to face legislative challenges from chiropractic
organizations. A consistent chiropractic strategy has been
to challenge physical therapists’ educational backgrounds related
to thrust joint manipulation and diagnostic abilities. Recently in one
state the Chiropractic Association requested that written evidence to
support the inclusion of joint manipulation, airway clearance techniques
and wound care be submitted including: scholastic catalogues of
ALL nationally certified PT school programs showing the number of
classroom and clinical training hours PT students receive in:
- Differential
diagnosis
- Pathology
- Radiology
- Neurology
- Chemistry
- Anatomy
- Physiology
- Microbiology
- Psychology
- Obstetric/gynecology
- Orthopedics
- Wound
care
- Spinal
manipulation
- Extraspinal
manipulation
- Airway
clearance techniques
In addition,
they requested documentation describing the educational levels of PT
students from five, ten, and twenty years ago! The above was
requested in the name of patient safety, a very credible concern,
but….
On what basis
will chiropractic organizations make their judgment on our level of
training? What will their standard or reference point be? Of
course they will find discrepancies in curricula when comparing PT
versus chiropractic education programs. We are two very different
professions when it comes to patient care approaches and the underlying
rationales that guide our educational training and clinical
decision-making. For example, in the state of
Wisconsin the key phrases
of the Definition of Chiropractic Practice Act are spinal
subluxations and associated nerve energy expression, and spinal
column adjustment. A completely different approach than what
you’ll find described in the Guide To Physical Therapist Practice
where the disablement model and evidence-based practice
are the central themes to our scope of practice. The assumption
would be that with approaches so different, the educational training and
general perspective would also be very different. In my opinion,
the analogy of comparing apples and oranges doesn’t do justice to
the differences in training and approaches. In fact, in many
aspects I would argue the two approaches may be incompatible.
Chiropractors
and their associations are not qualified to make judgments on our
educational standards and training, unless of course we were presenting
ourselves as practicing chiropractic. This is not what is being brought
forth legislatively by PT Associations. Stating we utilize
thrust joint manipulation is not synonymous with practicing
chiropractic. No single profession owns this intervention that has been
utilized for centuries (long before Chiropractic was
“invented”). Its in what context the technique is
being used and for what reason, is what differentiates the various
professions who use manipulation. So, in
Wisconsin if I state I am
using spinal adjustments to correct a spinal subluxation to restore
nerve energy, then it would be legitimate for a chiropractic association
or examining board to approach the Wisconsin PT Examining Board
questioning my actions and level of training. Of course I would
not claim this, in part because I don’t adhere to the vertebral
subluxation and nerve energy theory that drives their
profession.
All health care
professional associations have the right and responsibility to advocate
for public safety. It is a legitimate question to ask; will
patients be at risk if this legislative language goes into effect?
It is reasonable to be held accountable by other patient advocate
groups (e.g. other health professions). So how do we as a profession
respond to such questions? We simply describe our education and
our practice, as well as to whom are we accountable to in order to
insure quality and safety. The Guide to Physical Therapist
Practice, a consensus-based document, clearly describes our scope of
practice. How do we know if graduates from PT programs are
competent practitioners? The educational training provided by all PT
schools is clearly described in The Normative Model of Physical
Therapist Professional Education, another consensus-based
document. Another legitimate question is; how do we know if our PT
Programs are meeting the appropriate standards?
From 1936
until 1977 the American Medical Association oversaw the accreditation of
PT programs. Since then, the Commission on Accreditation of
Physical Therapy Education (CAPTE) has “served the public
by establishing and applying standards that assure quality and
continuous improvement in the entry-level preparation of physical
therapists and physical therapist assistants, and that reflect the
evolving nature of education, research, and practice”.
Who is CAPTE? CAPTE is the ONLY agency in the
United
States recognized to accredit
educational programs for the preparation of physical therapists. It is
the only agency with the expertise and credentials to pass judgment
regarding the scope and quality of physical therapists’
training.
So, how do we
respond to requests from groups like the above-mentioned Chiropractic
Association? We state that we appreciate their concern for public
safety. We follow with; “We share your concern about
patient safety. As a profession we have very high standards
related to patient safety in our Standards of Practice, Code of Ethics
and Guide to Professional Conduct; equal to any health professions
like-documents. We also have State Examination Boards, like other health
professions, charged by legislators to address concerns brought forth by
the public related to physical therapist practice.” We can
describe in general our educational training and standards, noting that
our educational programs are held accountable by an agency
“appointed” by the United States Department of Education, as
with other health professions. We can in general terms compare and
contrast education and approaches to patient care with other
professions, but discussing how many hours or minutes is spent on a
technique is not relevant and borders on the absurd. Constructive
dialogue and negotiations requires two parties willing to listen and who
potentially will change their positions. I fully understand this
2-way street of communication involving chiropractic organizations often
does not exist. Their objective is simply to restrict our
practice.
We
should spend as much time, if not more, educating legislators regarding
our training and practice as we do trying to convince other professions
that we are qualified. Regardless of who we are negotiating
with we have nothing to apologize for in terms of our training and
practice of thrust joint manipulation. It has been a part of our
practice for decades and physical therapists continue to be at the
forefront of research investigating appropriate use of this
intervention. The above is the message the Academy and APTA are
giving to the PT state associations when they are confronted by these
legislative challenges. I hope this is the message you will give
to all relevant audiences.
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