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    Position Affirms PT as Responsible and Accountable for Care

    A new APTA position passed last week by the House of Delegates will help support physical therapists practicing under new health care delivery and payment systems. Aimed at meeting the needs of patients and clients, the position recognizes that the physical therapist is responsible for the direction of physical therapy service and provides physical therapy service, or directs and supervises physical therapy interventions provided by appropriate support personnel.

    This position will take effect July 1, 2012, following a thorough, collaborative investigation of models of service delivery, beyond the current model in which the PT and the PTA are the only providers of physical therapy and are assisted by the PT aide. This investigation will be conducted by a Task Force consisting of members of the 2011 House, members of the Board of Directors, appropriate chapter and section representatives, other experts, and APTA staff and will also address any associated changes in current APTA positions.
    [RC 3-11, RC 4-11-RC 12-11] 


    Comments

    I have grave concerns regarding the position adopted by HoD regarding provision of services by supportive personnel outside the PT/PTA model. This opens the dooor for services by an array of who-knows-whats treating our patients. The most scrupulous of our profession will always be appropriate in delegating tasks. It is the other end of the spectrum I am concerned about. We have achieved the advancement of our profession relying on the provision of services by skilled, educated hands-on care providers, not by delegating to whomever is able to follow a rote assignment. I await the outcome of the investigation.
    Posted by Tom McNamee on 6/17/2011 3:48 PM
    I'm looking forward to ideas from our new Pavilion! Things are hard to find -but we will get used to the new arrangement.
    Posted by Paul Norton on 6/17/2011 3:51 PM
    I am also concerned with the position adopted by HoD regarding provision of services by supportive personnel outside the PT/PTA model. Why am I going to school to earn this degree of PTA if a tech can do the job without the education? It feels like a slap in the face! Does my education have no value? Who's interest is being served here.I think the HoD can do better to serve the whole profession. I hope the investigation will find a way to be supportive of the role of PTA's instead of shooting up in the foot.
    Posted by C. Stamper on 6/18/2011 5:22 PM
    I am thrilled that the APTA has moved in the same direction as every other doctor level professional regarding delegation. We go to school for seven years to learn and cultivate the skills to know what is best for our patients. Just like a dentist knows when it is appropriate to delegate to a hygienist, and just like a physician knows when to delegate to non professional staff, just like when a vetenarian knows when to delegate to a vet tech, a physical therapist is educated to know what is in their patient's best interest. Additionally, when insurance companies are only paying $50/visit in some states you can not lock the therapist's hands regarding delegation. We have to be able to offer PT services to ALL patients thru more economical methods.
    Posted by Linda J. Zane, PT, MPA on 6/19/2011 12:55 PM
    I have practiced as both a PTA and now as a PT and I find this position as being very troublesome. I see all my patients one on one for the whole treatment and use my time while performing US, Thera-ex or other modalities to cont to gain information from my patients. I supervise PTA and have them treat patients in the same manner. I find it troublesome to think of delegating these tasks to aids with less of a knowlege base. A fearful example would be a an US being performed over an area displaying signs of infection or possibly use of US head with a BNR that was off secondary to a cracked crystal, will an aid know to stop upon patients abnormal response. These kinds of arguments were the similer to those we brought up in argument to Chiropractors having their staff performing these task. I am strongly against this position.
    Posted by Vlad Kusznir on 6/19/2011 1:16 PM
    I am heartbroken. After 17 years of membership and actively promoting participation by fellow PTAs, I am devasted that the organization which I uphold has turned their back on me and all PTAs in this country. While I have very recently paid my membership dues for yet another year, I now think it will be my last. Why support an organization which obviously does not support me and stand behind what my education means? I know that I certainly will not, and neither will any of my family, pay for Physical Therapy as a patient from just any support person who happens to be working without a license! Emily DeLozier, PTA, former TN Delegate
    Posted by Emily DeLozier -> =NX`EL on 6/19/2011 3:42 PM
    Another middle-class profession bites the dust. Patients will be treated by a DPT and some untrained/unlicensed hack getting $10/hr. Further separation of the classes and worse care for patients. So much for PTA school.
    Posted by Paul McCarty on 6/20/2011 1:54 PM
    Unless and until APTA supports the PT/PTA model as it's official position, APTA must not take membership dues from PTA's. It is unethical for any organization to take membership dues from those whose best interests they do not, or will not, represent. Further, all PTA memebership dues should be put aside and/or refunded until APTA has made its position on PTA's clear Thank you
    Posted by James Heller on 6/22/2011 1:02 AM
    Physical therapy should be provided by physical therapists and physical therapy assistants. As a private practice owner i do not use aides to provide treatment to our patients. I know private practice owners are divided by the arguement that we know when it is appropriate to delegate, but billing for physical therapy provided by a tech or aidee feels unethical to me. My practice is grwoing, profitable and the community knows they are getting the best care around. I'm a PPS member and don't agree with the position that physical therapy can be appropriately provided by techs. It's a slippery ethical slope and I hope HoD doesn't go down that slope. Nancy Reynolds, PT, MEd, SCS
    Posted by Nancy Reynolds -> =JW\= on 6/22/2011 10:22 AM
    I too have grave concerns about allowing this.I worked too hard for my degree. I understand there are some very talented people out there working as aides and ATC but they are not therapists and should not be billing as such. I do have the knowledged to know when it is appropriate to delegate under my supervision but that person should be licensed! You think we have problems with reimbursment from insurance companies now, just wait.
    Posted by Gerriann Samowski on 6/23/2011 12:35 PM
    This position is a mistake. It effectively sacrifices the role of PTA's in patient care in the name of profit. We can and MUST do better than this.
    Posted by Jon Elder on 7/1/2011 4:53 PM
    Where should I start? Unethical, Unsafe, Unlicensed, Wow APTA! Seriously? This is beyond ridiculous! Greed also plays a part. I went to school for a total of 3 years including pre-reqs. This is a blatant slap in the face.
    Posted by Brent Taylor on 7/2/2011 3:47 AM
    We need to continue putting pressure on the HOD to recind RC 3 - 11, or lay out some reasonable 'PLAN of CARE'. I agree that it is a total waste to dumb down the college educated individuals who have spent money, time, energy to be the assistant of those who pull the rug out from under them. PTA's are highly intelligent, and it frustrates me to no end to be treated as a lesser professional. It is unethical to take money from someone that you plan to not represent. It is their fiduciary responsibility to represent the WHOLE population of it's members and not just the part.
    Posted by Polly Bowers-Maness, PTA on 7/5/2011 11:11 PM
    I am a non-traditional student that has endured many obsticles to be admitted into a highly competitive PTA program. It pains me to think that my well planned course of education over the past couples years could be for not. I don't want to get rich, I want to help people and be able to support myself financially. A further flooded job market, with non-physical therapy trained part-time employees will directly undermine my plans and hopes for a quality of life I have been fighting to achieve. Please no!
    Posted by Richard Findley, PTA student on 8/24/2011 9:36 PM
    I think it will be very interesting to see how this works out. I have read many discussion forums on this subject and have found very, very few pt's or (obviously!)pta's that support it. If this passes and gets put into practice it will show that the APTA does not listen to it's members. Furthermore it would highlight a gross misuse of power by the board members of this organization and as a member I will not forget what happens. I have never been so disappointed in this organization.....I believe that this is irresponsible and is taking advantage of members of the apta. How can a pta pay dues to have their interests protected by an organization-only to have that organization turn around a attempt to remove their place in the profession? It makes me sick to my stomach.
    Posted by Chad Nichols on 9/22/2011 4:23 PM
    I'm absolutely dumbfounded that this actually passed. And to euphemistically call it an affirmation of PTs' responsibility and accountability? Please. Has the HOD forgotten why the PT/PTA model was taken up in the first place? Because some PTs are unscrupulous enough to take advantage of the freedom to hire and delegate to whomever they choose in the name of profits. And I'm sure that hasn't changed. And what about protecting the interests of your other dues-paying members, the PTAs? And you wonder why PTA membership is down!
    Posted by Jake on 10/15/2011 8:52 AM
    After carefully reading RC 3-11 & 4-11 I am amazed at how unethical the APTA is appearing to be on these 2 topics. They are clearly not standing up for the PTA's, however, we can stand up for ourselves by being a strong part of the process and a thorn in the side of the ones pushing this through for whatever reason that they are. I say that every member should stand strong and UNITED. If not, before ya know it, they will have the surgeons writing scripts, (just like the did in the old days)and then possibly disregarding the DPT's the same way, (letting the aides follow out the script that the MD wrote out.) If they will turn their backs on one they will turn them on another. Unite vote against it and save both our profession's and possibly lives. Or sit back and watch our friends and coworkers loose what they worked so hard to obtain.
    Posted by Gregg Erwin, PTA Student on 10/17/2011 2:23 AM
    A comment was removed because it violated the site's Terms & Conditions, which include: "Do not post anything that is ... profane, vulgar, obscene..." Please review the Terms & Conditions here: http://www.apta.org/TermsConditions/
    Posted by News Now Staff on 10/17/2011 7:36 AM
    This is an unbelievable slap in the face. After being drilled on ethical values and how I personally have been valued for the past 23 yrs. as a P.T.A, it mortifies me that I have now become a disposable entity. Sad that I have seen my own profession value a "buck" over truly "skilled" delivery of patient care.
    Posted by Charmin McCoy on 11/1/2011 7:55 PM
    Hello Colleagues, I am currently a 3rd year PT student and I had the privilege of attending the APTA House of Delegates this summer as a student usher. I have also been licensed as a PTA for over four years. I thoroughly enjoyed listening to the debate regarding this RC at the APTA HOD. I will admit my bias as a licensed PTA, but I do not support this position change by the APTA. First of all, when in PTA and currently in PT school I have learned that a PTA's scope of practice isn't as broad as a PT's, but it is totally encompassed by the PT's scope. Not knowing what the scope of practices are for ATCs or Exercise Physiologists, does their scope totally and completely fit under our scope as PTs? If not, then should we as PTs be supervising them based on their scope of practice? The answers to those two questions, seem like an obvious NO. I understand that their scope and our scope may overlap in some, if not many ways. However, we should only be supervising within our scope and PTA's should be educated and trained to do all and possibly more than any other support staff within the scope of PT. Now a PTA cannot do all that a PT can do, but neither can any other support staff. So, to me the argument that other support staff has more expertise within the scope of PT than a PTA, does not hold weight for me. I understand that those other professionals have different training and expertise than PTAs, but those areas may be outside of our scope as PTs and if not I would argue that the PTA should be able to do it. I also understand that sometimes PTAs have a broader base of training, but are not as skilled in more specific aspects within our scope, such as sports specific training. However, I believe the APTA is addressing this need by encouraging PTAs to work towards advanced proficiency recognition. I also feel that PTAs can expound on their base of knowledge and gain the appropriate amount of expertise within their scope through experience within a certain setting. The other argument I heard is that in many cases there isn't enough PT support staff to reach the patients that need physical therapy. This is especially the case in rural areas, which is a valid concern currently in my state of Idaho. However, I hear about how many PTA schools are becoming accredited throughout the nation (and here in Idaho), and there is great worry that there aren't going to be enough jobs out there to employ all the licensed PTAs. Maybe the APTA needs to put more time & focus to supporting legislation that encourages both PTs and PTAs to practice in rural areas which would create more job options for graduating PTAs and would give those PTs practicing in rural areas more available support staff. I guess I do not see how these two arguments indicate that the APTA should change their position to allow for "other support staff" as deemed appropriate by the supervising PT, as we already have the most appropriate support personnel in PTAs. I have not been trained as an ATC or Exercise Physiologist, so I may have misspoken on some aspects in this e-mail, but I have tried to speak based on my training as a PTA and current training as a PT. Please correct me where needed.
    Posted by Nash Johnson -> @HS]DF on 11/11/2011 4:28 PM
    I cannot believe that this legislation was passed. In this litigation-crazed society I can just see it now: LAWSUIT. Patients come into a clinic and pay to receive skilled service. Why are we going to let anyone who is deemed "appropriate" put their hands on a patient if they are not trained properly. If the legislation reads that anyone can perform PT services it is obvious that some PTs are going to hire a 10/hr employee to do it. I work with some of the best, but I have seen the worst in people, especially when it comes to saving a buck. Also, why have we worked so hard to define our scope of practice? Why should I pay APTA dues and take a national exam to prove that I know what I am doing if anyone can just step right in and take my job? Obscene!!! Also, APTA, you should no longer accept dues from PTAs bc you obviously think very little of us as professionals.
    Posted by Karen Falkler on 12/7/2011 7:01 PM
    RC 3-11 is not final. The APTA is simply investigating this position using a Task Force of PTAs and PTs until July 1, 2012. Per the APTAs FAQ: "the position could remain as is, be amended, or be rescinded as the House sees fit based on the recommendations that result from the investigation." In other words, get involved, write the APTA, voice your concerns, stick to the facts. We can still stop this ridiculous rule before it is fully implement on July 1, 2012. Email your concerns to the PTA Caucus, see emails here: http://www.apta.org/PTA/Caucus/
    Posted by Josh McCarthy on 12/11/2011 6:23 AM
    I agree with this: RC 3-11 is not final. The APTA is simply investigating this position using a Task Force of PTAs and PTs until July 1, 2012. Per the APTAs FAQ: "the position could remain as is, be amended, or be rescinded as the House sees fit based on the recommendations that result from the investigation." In other words, get involved, write the APTA, voice your concerns, stick to the facts. We can still stop this ridiculous rule before it is fully implement on July 1, 2012. Email your concerns to the PTA Caucus, see emails here: http://www.apta.org/PTA/Caucus/
    Posted by Rob Sheer on 12/11/2011 6:27 AM
    There are many reasons to support this piece of legislation. Much of what is suggested in RC 3-11 is already being done in many practices. Several classmates have confided that they as aides were putting e-stim on patients and guiding them through their exercises and setting up machines. It’s understandable that PTA’s will feel threatened by RC3-11. However, there is more than enough work to go around and there truly are other qualified and certified support personnel that we as doctors of physical therapy are more than equipped to supervise and mentor. Why limit ourselves to PTA’s? On my 2nd clinical affiliation we did not have any PTA’s, but instead had athletic trainers, ASCM certified personal trainers and well trained aides. We also went to a nearby college and worked in an athletic training room once per week. What I discovered working side-by-side athletic trainers is that they already use many of our modalities, for example, e-stim, ultra-sound and taping. They had the machines and the equipment there in their office. I observed athletic trainers using the before mentioned modalities on athletes, describing the use and discussing contraindications correctly. Most athletic trainers and exercise physiologists go to school for a longer period than PTA’s. ASCM certified personal trainers usually really know what they are doing because they have standardized testing and one must have good knowledge base of conditions in order to pass their test. At my clinical, I supervised athletic trainers, massage therapists and aides who set up e-stim (according to settings I had set) and at times underwater ultrasound (according to my settings). I also supervised them while they set up machines and gave verbal feedback to patients performing exercises that they had performed many times before under PT direct supervision and guidance. At first, this status quo alarmed me because as I was taught in school that we only should supervise PTA’s and aides can only legally handle ice and heat. Not once did an accident happen, nor did someone do the wrong thing that hurt a patient because those that were hired and working were well trained and also because we as PT’s were always there supervising, giving input and support to both patients and support personnel while we simultaneously manually treated a patient. Regardless of what happens, it is always our license that is at stake, which means it is in our best interest to closely supervise when necessary and use proper judgment when delegating. We have clinical doctorates much like a dentist has a clinical doctorate of dentistry. We go to school for longer periods of time then physician assistants, occupational therapists, speech therapists and many other health care providers. Because of the high demand for our services, at times and in certain under- deserved locations, we are best utilized doing thorough examinations and patient goal and treatment planning as well as manual therapy. I support this piece of legislation because I believe it only gives us more freedom, autonomy, accountability and the opportunity to more easily and legally outsource to the appropriate team members.
    Posted by Jane Foody on 12/15/2011 3:37 AM
    A comment was deleted because it violated the site's Terms & Conditions. While we encourage professional debate of issues, personal attacks will not be posted.
    Posted by News Now Staff on 4/24/2012 7:46 AM
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