Selena -

All of this data is great, and I totally agree. However, the infographic doesn't account for the hidden (or overt) agendas and misguided incentives that ultimately drive the discussion. If it was all about the evidence, then every state would have direct access to physical therapy, billions of dollars would be saved, patients would have greater access given an open (non-gatekeeper) marketplace ... and yet the evidence for this existed a decade ago.

So what is to be done when the evidence is consciously ignored?

Mike: I think the answer lies in PT experiences outside of the US. The DPT as an entry level degree is a US phenomenon. Vision 2020 outlined the move to the DPT. I can remember being told it was going to help public perception, help us attain direct access, yada yada yada. Since 2000, there has not been any change in the number of states having unrestricted (or what I call "real") direct access. I think the number stands at 17. So how effective has it been in "moving the profession forward"?

The perceived lack of professional autonomy - the self image problem I mentioned earlier - is definitely a US phenomenon as well. You can look at many other countries - those that have Bachelors and Masters as the entry level degree - and a large number (if not the majority) are direct access.

Mike: Thanks for your comments. I would agree - the problem starts with how we view ourselves and our own professional autonomy.

If you see yourself as an ancillary provider waiting for external stakeholders (incl. referral sources) to make decisions for you and your profession based on their agendas (and you are prepared to allow that to happen), then consumers will see you as such. Fortunately, the opposite is also true. If you see yourself as a "self determined, independent, autonomous practitioner", and behave in accordance with such (i.e. not accepting the agendas imposed by external stakeholders), then consumers will see you as such.

Unfortunately, the profession has been focusing on external solutions, not internal ones. We hear that in the "excuses" of why the profession is struggling - "it's a problem with reimbursement", "we need to have the DPT as entry level, people won't accept us until we are have a doctor designation", "its their [insert name] fault that we are where we are" etc etc. The fact that in 2012 we are still heatedly debating responsibility, accountability, and delegation says everything to me. Vision 2020 has been around since 2000. We have had 12 years of a vision that espouses "independent, self-determined, professional judgment and action". I think it is time for us to look within ourselves for that answer, and not point fingers elsewhere.

Brennan - try having that discussion with PTs from other countries. This "not for every PT" etc is an American phenomenon.

Based on what you proposed, I (and the majority of the profession) would not currently qualify for your "granting of access". That would be in spite of having 24 years of clinical experience and being a Diplomat in MDT (with clinical residency) - though no DPT. Gotta love that spirit.

A PT that "does not feel comfortable having that responsibility" needs to realize that they already have those responsibilities of patient care built into their practice act. Better yet, students might not want to enter the world of PT if they are not prepared to accept the Vision 2020's "self-determined, independent, autonomous practice" statement - from 2000. Current member clinicians that aren't prepared to embrace it - same thing. And if you are not prepared to accept that, then please, move out of the way for those that are. Reaching for the lowest common denominator won't help anyone.

Catrin - As a PT trained in Canada, I completely understand what you are saying. Ontario (my home province) has had direct access since the early 1990s - and that with an entry-level Bachelor's degree in PT. The logic of "must have a DPT, still don't understand autonomy" in the year 2012 is ridiculous.

GA DPT - You might want to check in any number of current PT practices. There are plenty of PTs doing exactly what you describe - just not prescribing medication. "Best practice and care" is autonomous, independent, self-determined practice, first and foremost.

Luke: Very nicely stated.

You said "all the other stakeholders are laughing and positioning themselves" ... well, there isn't much positioning to be done or energy to be expended by them if this does not pass!

Today will tell us one key thing: does the profession need an extreme makeover and self image intervention, or not?

Allan

"Some form of direct access" - a phrase that means little to the consumer. A consumer either has it or they don't. It is pointless for the APTA to candy-coat this. I think the net change in the last 12 years - for real consumer direct access - is zero. Seventeen states in 2000, seventeen states in 2012.

"We're FINALLY not being seen as the guys who can fill an order for stretches, hot packs, and ultrasound" - no, we're liable to be seen as the profession that couldn't decide their own professional autonomy in a room full of their peers. That concerns me even more.

John:

I would agree wholeheartedly. The fact that this is even an issue at this point - one that apparently merited discussion ad nauseum in the House of Delegates today - bewilders me. You are either an autonomous profession - or you aren't ... much like a consumer either having direct access - or not. Simple.

Allan

"... While most staff practitioners, educators, and PT/PTA students are against ... you've got to look out for that bottom line - right?"

Perhaps you could ask the educators about that whole "bottom line" issue with the DPT. An entry-level degree now costs over $100,000. So who was looking out for the bottom line in 2000? Admittedly a separate issue, but let's not use "bottom line" as an exclusive issue for private practice owners alone.