Primary Care and the Physical Therapist: Lessons From the Military
By Jason Silvernail, PT, DPT, DSc
If you keep up with the news, you may have seen headlines like these: "Doctor shortage may reach 120,000 by 2030," "How can we remedy the shortage of health care providers?" and "US faces looming shortage of primary care physicians."
Given the importance of primary care, this isn't good news. To address this shortage, medical schools have increased enrollment, hoping to graduate more primary care physicians. But there are other ways to meet the demand for primary care than just producing more medical doctors, as the US military can teach us.
Several times in its history, the US military has experienced critical shortages of physicians. As a result, after the Vietnam War the military had to develop models of health care that can be an example for a civilian practice environment facing the same problem. Surely if these approaches—validated through reviews of military medicine by organizations such as The Joint Commission and the National Committee for Quality Assurance—are successful for our men and women in the military, they should be considered seriously as options to improve the supply of civilian primary care providers!
Primary health care teams in military medicine are constructed with a basic set of capabilities in mind and can include physicians, nurse practitioners, physician assistants, physical therapists (PTs), and behavioral health care providers such as psychologists and social workers. This "capabilities model" allows these licensed independent providers to work at their full level of training, share responsibilities, and help get the right patient to the right provider in a timely manner to provide effective care.
The military's health care teams often rely on what's known as "capabilities-based assessment": it determines what functions (capabilities) need to be present for success and then identifies resources to provide those functions. Instead of relying on old models and assumptions of how things have always been done, teams develop new solutions that are matched to the details of the problem.
There may be barriers to translating such a model to civilian care, such as high copays and Medicare not recognizing PTs as primary care practitioners, but such barriers are based on health policy, not on medical necessity or appropriateness. After all, PTs aren't seeking to replace primary care physicians but to provide primary health care within the scope of their training and expertise—care that is low-cost, low-risk, and proven effective for many common medical conditions that bring patients to primary care providers.
Primary care providers in team settings need to be able to evaluate and manage a wide variety of injuries, illnesses, and disorders—and no one profession can do it all. An ideal primary care team will be able to triage and direct the patient to the right team member. For example, the patient with the acute sports injury to the physical therapist, the cough and fever to the nurse practitioner, and the acute anxiety reaction to the psychologist.
PTs in the US military are right now stationed all over the country and around the world working in primary care teams managing acute sports injuries, dizziness and balance problems, pelvic pain, nerve injuries, wound care, and of other illnesses, injuries, and disorders well suited to their expertise. Easy access to PTs allows military members and their families to get rapid access to low-cost, low-risk, high-quality care. Using a team-based model in primary care helps foster trust and teamwork as different providers learn to share the overall workload while matching patients to the right provider.
No single provider can do it all—that's why you need a team. PTs are ready now to take on this team role, if we are willing to confront the policy obstacles that stand between Americans and the quality care provided by doctors of physical therapy as part of primary health care teams.
Jason Silvernail is a career Army officer and works in hospital leadership in the Washington DC area. Statements appearing here are Dr Silvernail's personal opinions and commentary and do not reflect the official policy or position of the United States Army, the Department of Defense, or the US Government.
Editor's note: Are you practicing as a primary care PT or working in primary care? APTA wants to hear from you! Contact Hadiya Green Guerrero at firstname.lastname@example.org or Jeannie Bryan Coe at email@example.com for your personal survey link.