CONTEMPORARY Chapter 3

PRACTICE ISSUES
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Physical therapy, by 2020, will be provided by physical therapists
who are doctors of physical therapy and who may be board-certified
specialists. Consumers will have direct access to physical therapists
in all environments for patient/client management, prevention, and
wellness services. Physical therapists will be practitioners of choice
in clients’ health networks and will hold all privileges of autonomous
practice. Physical therapists may be assisted by physical therapist
assistants who are educated and licensed to provide physical
therapist–directed and –supervised components of interventions.
(APTA VISION 2020)

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CONTEMPORARY ISSUES
1. The Doctor of Physical Therapy (DPT) & Post professional DPT
2. Board certification of specialists
3. Direct Access and autonomy
4. Physical Therapist assistants
5. Research
6. Evidence based practice
7. Scope of Practice
 Practice patterns
 Broadening the practice context
8. Political Reaction
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DPT

The professional doctorate is the appropriate

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DPT provides PTs with a clear professional identity consistent with
that of other health care professionals (e.g., podiatrists, pharmacists,
psychologists, and chiropractors).
image of the PT should be consistent with the public’s expectations
of a professional (i.e., competence, trust, and autonomy of decision
making) and that the doctoral degree recognizes and enhances such
an image.

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needs of health care consumers determine not only the demand or
need for physical therapy services but also social status of physical
therapy as a profession, which in turn would require preparation at
the doctoral level
Finally, adoption of the professional doctoral degree would be
advantageous in presenting the professional obligations and
responsibilities of PTs

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 DPT: PERSPECTIVE OF THE
PROFESSION
DPT programs prepare students for the unpredictable future of
clinical practice, which they saw as one in which PTs will be
1. More directly involved in the processes of evaluation,
diagnosis, and patient management
2. Delegating and supervising treatment
3. Writing clinical case reports
4. Documenting the use of outcome data
5. Educating patients, families, students, and peers, as well as
individuals and agencies not directly involved with the
physical therapy profession
6. Confronting ethical and financial dilemmas imposed by
shrinking health care financing.
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 DPT: PERSPECTIVE OF
THE PRACTITIONER
A key issue for the profession is the conversion by 2020 of
licensed PTs with bachelor’s and master’s degrees to PTs with
DPT degrees.
Having all PTs hold the same degree designation will reduce the
public confusion that arises when the same professionals hold
multiple degrees.
As PTs become more homogeneous, they will be more easily
identified as the primary providers of care for people with
movement dysfunction
The ill feeling that might emerge among professionals regarding
the value of an academic degree versus the value of experience
can thus be diverted.

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The DPT will help eliminate individuals who are not willing to “go
the extra mile” for the profession.
The DPT will distinguish PTs from other allied health practitioners
such as massage therapists, athletic trainers, and kinesiotherapists.

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BOARD CERTIFICATION OF
SPECIALISTS
The APTA House of Delegates approved the concept of
specialization in PT practice in 1976, and the requirements for
certification in advanced clinical competence were approved in
1978.
Appointment of the first nine-member American Board of
Physical Therapy Specialties (ABPTS) followed shortly
thereafter, and subsequently the first specialty council in
cardiopulmonary physical therapy was established, which
developed criteria and a qualifying examination for this specialty.
Over the years, specialty councils have been created for clinical
electrophysiology, geriatrics, neurology, orthopedics, pediatrics,
and sports physical therapy

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THE BRANCH OF PHYSIOLOGY THAT
DEALS WITH THE ELECTRICAL
PHENOMENA ASSOCIATED WITH
NERVOUS AND OTHER BODILY ACTIVITY.

The branch of physiology that deals with the

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BOARD CERTIFICATION
OF SPECIALITIES
 Concept of Specialization in PT practice.

Peadiatric
Orthopedic Cardiopulmonary

Specialization Neurology

Sports Geriatrics

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PERSPECTIVE OF THE
PROFESSION
The decision to develop a board of specialization for PTs was based
on the need to formally recognize PTs with advanced clinical
knowledge, experience, and skills in a specialty area of practice so
that they could be identified by consumers and the health care
community.
Specialization is believed to promote (1) the highest possible level of
care for individuals seeking physical therapy services in a specialty
area and (2) the development of the science and art underlying the
specialty.

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Most physicians seek board certification as specialists; will a similar
trend develop for PTs?
What are the implications if those who choose to specialize come to
outnumber those who do not?
Will PTs identify more with their specialization group than with the
general profession?
Will specialization generate competing
professional organizations of PTs as the number certified in each
specialty grows

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What impact will increased specialization have on health care costs
and quality of care?
Given the ever-expanding knowledge base, can PTs continue to be
generalists?
Can specialization thrive under managed care, with its emphasis on
efficiency?
Does an alternative mechanism for advancement exist for PTs who
are not interested in the administrative career path?

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DIRECT ACCESS
Perspective of the Profession
“Direct access is the ability of a physical therapist to provide
evaluation and treatment to patients without the need for a physician
referral.”
The public is best served when access is unrestricted.
The primary rationale for this position is that direct access
eliminates the burden of unnecessary visits to physicians to obtain
physical therapy services, which can result in delays and denial of
services provided by PTs.
The delays in care result in increased costs, decreased functional
outcomes, and patient frustration.
PTs believe that their extensive education and clinical training make
them well qualified to practice without referral, at no increased risk
to their patients’ health, safety, and welfare
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These practice acts are typically discussed in terms of those that
place no restrictions on physical therapists in the evaluation and/or
treatment of patients without a physician’s referral and those that do
have restrictions.
For example, many jurisdictions allow the PT to perform only an
evaluation initially; the patient then must be referred to a physician,
who must approve the PT’s plan of care before it can be
implemented.

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Objections to direct access included (1) the belief that education of
PTs was not sufficient to allow them to serve as initial contacts for
entry into the health care system; (2) the risk that serious medical
problems might be missed in systems other than the musculoskeletal
system; and (3) the fear that increasing the autonomy of PTs would
shift them to private practice and create staffing shortages in
hospitals

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DIRECT ACCESS
Perspective of the Practitioner
Some PTs want direct access others don't??
Lack of knowledge and skills
Not willing to take full responsibility
Happy with referral system
May be number of patients/client reduce

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PHYSICAL THERAPIST
ASSISTANTS
Physical therapy is defined as the care and service provided by or under the
direction and supervision of a physical therapist.
Physical therapists are the only professionals who provide physical therapy.
Physical therapist assistants—under the direction and supervision of the
physical therapist—are the only paraprofessionals who assist in the provision
of physical therapy interventions.
Examination, evaluation, diagnosis, and prognosis should be represented and
reimbursed as physical therapy only when they are performed by a physical
therapist.
Intervention should be represented and reimbursed as physical therapy only
when performed by a physical therapist or by a physical therapist assistant
under the direction and supervision of a physical therapist.

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PHYSICAL THERAPIST
ASSISTANTS
The PTA is a technically educated health care provider
who assists the PT in the provision of physical therapy.
In the contemporary provision of physical therapy
services, the PT is considered the professional
practitioner of physical therapy, and the PTA, educated at
the technical level, is considered the paraprofessional.
These definitions specify the exclusivity of the term
physical therapy (often phrased as, “It’s only physical
therapy if a physical therapist does it”) and then extend
the term’s use to include services provided by PTAs under
the direction and supervision of the PT.
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THE GUIDE—AN
EXTRAORDINARY
ACHIEVEMENT
By arangments of FPTA, Contributions from more than 600 experts
in various fields were fine tuned and integrated, and in 1997 the
Guide to Physical Therapist Practice was published. (Its current title
is the Interactive Guide to Physical Therapist Practice with Catalog
of Tests and [Link] publication has come to be known simply
as “the Guide.”

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THE GUIDE SERVES THE
FOLLOWING PURPOSES IN THE
PROFESSION:
i. Describes PT practice in general
ii. Describes the roles of PTs in primary, secondary, and tertiary care; prevention; and
promotion of health, wellness, and fitness
iii. Describes the settings in which PTs practice
iv. Standardizes the terminology used in and related to PT practice
v. Establishes the tests and measures, as well as interventions, used in PT practice
vi. Delineates preferred-practice patterns to help PTs accomplish the following
vii. Improve the quality of care
viii. Enhance the positive outcomes of physical therapy services
ix. Enhance patient satisfaction
x. Promote appropriate use of health care services
xi. Increase efficiency and reduce unwarranted variation in the provision of services
xii. Diminish the economic burden of disablement through prevention of poor health
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practices and promotion of health, wellness, and fitness initiatives
SCOPE OF PRACTICE

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THE APTA /PPTA AND
POLITICAL ACTION
Political Action Committee
The Physical Therapy Political Action Committee (PT-PAC) states
that its purpose is to “ensure that physical therapy maintains a
forceful voice in the halls of Congress.”

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 Thanks
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