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PT Whore of the Month Club #2

February 26, 2008 by

The inaugural PT “Whore of the Month Club” feature was received with great fanfare, so we will continue the monthly feature for a while and see how it goes.

The Feb 2008 winner of the PT Whore of the Month Club is…drumroll please…

Paul Duxbury for his recent submission in a so called peer-reviewed journal describing how to open ancillary POPTS/RFP clinics. There’s not much worse than a PT undermining his own profession (and please, don’t tell me he has the patient’s or our health care system’s best interest in mind). Let’s just throw Orthopaedic Clinics of North America into the mix as well for having published an entire issue on how to use ancillaries as alternative revenue streams, which serve only to drive up utilization and costs. It’s really a shame that a scientific journal no less borders on treacherously unethical boundaries (and I would argue flat out crossed the line and prostituted themselves).

Ah heck, while we’re at it, why not just collectively throw all PT’s working in physician and chiro owned clinics into the mix. APTA can take a ”hate the sin but love the sinner” strategy, but that doesn’t mean we have to.

Keep sending in your ideas via email at info@evidenceinmotion.com or feel free to post as comments!

The EIM Team

Previous PT Whore of the Month Winners:

Jan 2008 – WebPTPT Whore of the Month Club #1

Disclaimer:

In the event that anyone is concerned with our use of the word “Whore”, we are referring to definition #4 below.

whore-

1. a woman who engages in promiscuous sexual intercourse, usually for money; prostitute; harlot; strumpet.

2. to act as a whore.

3. to consort with whores.

–verb (used with object)

4. Obsolete. to make a whore of; corrupt; debauch.

27 Responses

  1. CJK says:

    While I appreciate the spirit of what you are posting, as a woman and a professional I find the use of the word ‘whore’ a bit distracting to your point. (Despite the disclaimer statement.) Would you consider an alternate synonym, like ‘venal’?

  2. Sarah Luna says:

    In response to the title of the blog… it definitely got my attention and it got me to read the content! Now back to POPTS, I’m losing orthopedic referrals to these clinics left and right. Anybody have any words of wisdom on how to compete with these guys???

  3. Jason W. says:

    Does anyone have access to the article? I’d really like to see just what he has to say (know your enemy). I can’t bring myself to pay to read it however.

  4. Jason Silvernail says:

    Kudos to the EIM team for calling it like it is and not being afraid to use professional censure to advocate for our patients and our profession!

  5. John Ware says:

    “Whore” has the impact that this issue needs. It’s the right word at the right time for the right individuals, certainly including this guy.

  6. Todd says:

    I fully support the term in it’s context and on a side note I found it funny when I opened myphysicaltherapyspace in the top right hand corner of the page the first ad was for a job in Irving Texas that is a known POPTS.

  7. John Childs says:

    Todd:
    What ad are you referring to? PTJobs (the ads that appear on our sites) has an “anti-POPTS” position, so to get posted on PTJobs, an employer has to verify they are not a POPTS. Please provide details regarding the ad you’re referring to, and we can address. Thanks.
    John

  8. Todd says:

    John,
    The ad I was referring to was from PTJobs.com. Look under Irving Orthopedics and Sports Medicine, it’s owned by 5-6 ortho surgeons and located in Irving Texas. Check out their web site.
    http://www.irvingortho.com/

  9. Sarah asked how to compete with POPTS? Our approach has worked very well… market openly and relentlessly directly to the patient-public, always with the message that it is up to you, the patient, to tell your doctor where you will be goping for your PT. The objective is to get the patient to stand up and demand their right to choose where they go for PT. All our weekly display ads have this as the closing line in the ad… “It is YOUR choice where you go for PT, not your doctor’s”

  10. John Childs says:

    Todd:
    The ad has been deleted on our feed. We have also refunded the money to the company.
    We require each company that wants exposure on our site to read the terms of use and agree that they are not a POPTS. This company listed themselves as Private Practice. For the most part, the companies that choose this option are legit and do not try and circumvent our rules and guidelines.
    Thanks for calling this one out. Let us know if you ever see others. The only way a POPTS would show up is for them to call themselves something that they are not.
    John

  11. LAS says:

    Have to agree with CJK in earlier post regarding choice of use of the word “whore”. I too, appreciate the efforts of those who continue to be our “identity watchdogs”, however the term “whore” regrardless of the stiputlation, I find to be degrading and a bit too garrish and unprofessional. Do we really need to be that “IN YOUR FACE” to get the attention you are looking for, or might we chose to retain some modicum of professionalism and look for another adjective to make your point.

  12. John Ware says:

    “Do we really need to be that ‘IN YOUR FACE’ to get the attention you are looking for…”
    Yes! I think the “in your face” method is a refreshing change from the “doormat” approach we’ve been using for the last 50 years, which has gained us very little in terms of respect, autonomy, identity or recognition outside of our field.
    It’s time to wake up, people! A cold splash of water in the face is in order.

  13. Jeff Hathaway says:

    I think one of the goals of this site is to challenge us, wake us up in some regard, increase awareness and move the profession forward. However, I have to say when I first saw the reference of “whore” I too was taken back – so the shock works – While it may be the right term to use based on the definition (#4), is it the most effective “tag” given the overall goal of this forum? Jeff

  14. Jason Silvernail says:

    I agree completely with John Ware. It’s time we called things as they were, shed our “peace genes” as John Childs says, and advocated for our patients and our profession.
    In science, strong dissent is encouraged – not a “tea party” atmosphere. As John Ware said above, we’ve been doing that for a long time, and it’s not gotten us anywhere…

  15. Harmony Choi says:

    I am a new PT graduate and am trying to understand the dangers of POPTS. In PT school, we were introduced to some of the ethical concerns of working for POPTS. But are there actually some POPTS that are legitimate where MD’s only send pts that have a true neccesity for PT? Are they all dangerous or detrimental to our profession? And what are things to keep in mind if you work for a POPTS? I am just trying to understand what the concerns are. Thanks!
    Harmony Choi

  16. Vince says:

    I think the use of “whore” is perfect. It might offend some people initially, but it gets the point across quickly and draws in the curious.
    If you’re worried about offending people, keep in mind that PETA called the town of Fishkill, NY a few years ago to complain that the name “fishkill” is offensive to fish and demanded that the town changed the name to “fishlive”. “-kill” is a dutch word for “stream” and many of the towns in that area have the name “kill” in it.
    Long story short…..someone is going to get offended no matter what you do.
    Good work John!

  17. sean says:

    Harmony,
    I will refer you to the archives of blog posts regarding POPTS on this site.
    To summarize, anyone benefitting financially from their own referrals brings up all kinds of conflict of interest issues. If you knew your homebuilder was getting a kickback from the subcontractor who laid the foundation of your house, and charging you full price, would you feel cheated? You know the sub is going to build the kickback into the price of the job and you end up paying for the GC’s profit margin and the kickback.
    These same supposedly ethical POPTS advertise for new docs enticing them with an extra passive income stream from PT. Now if you had $100,000 in student loans, where would you work? The place that pays you 200K only, or the place that pays you 200K plus an extra 20K in passive income generated from your own referrals?
    Oh and don’t forget if your productivity isn’t 3X the legal limit for Medicare patients, you may lose your job. While the MD’s may lose their facility license for PT, when Medicare investigates them, you may lose your license and career. So is it worth the extra 15-20,000 dollars a year in salary to “treat” more patients than you can possibly provide quality care for?

  18. John Ware says:

    Harmony,
    Sean’s dead on with that synopsis of the pitfalls of referral-for-profit (RFP).
    BUT, the reality of our health care reimbursement system is such that what you do (procedures) is more important than what you achieve (outcomes). Greedy, unethical and ignorant people in health care are willing to exploit that for their personal gain at the expense of patients.
    Don’t be one of them.

  19. Harmony Choi says:

    John and Sean,
    thanks for your comments. I have been temporarily working PRN at a POPTS for this past month (which is why I’m so concerned about this topic). I have approached the PT supervisor about my concerns about a POPTS, but so far all they’ve told me is that there are strengths in having MD’s so close in proximity for constant communication. I have no other intentions but to be an advocate for my patients and for our profession, but so far nothing “seems” unethical about this particular facility.
    Like you said John, I have quickly grown accustomed to the emphasis and greater concern on the procedures I can charge vs. the outcome of the patient or what the patient really needs. But doesn’t that happen anywhere, whether it be RFP or just a regular PT owned clinic?

  20. sean says:

    Harmony,
    There is a difference between, for example, having a patient ride a bike for 15 minutes to squeeze out another unit of 97110, and having the patient ride the bike for an evidence-based, therapeutic outcome.
    Regarding the communication POPTS PTs like to hold so dear to their hearts, you can have that without being in an environment where the referral source generates income on his own referrals. It’s called calling, emailing, or visiting the doc in person.
    Can you answer why being in the same office is more beneficial than just having the doc return a phone call? Let’s use a surgeon as an example. Is that surgeon always in the office, or is he in surgery half the time? Where is the constant communication in that situation? The communication argument is a self-serving one, in which the doctor allows or disallows based on $, not skill.
    My opinion is that the doctor should take the same amount of time responding to outside PTs’ communication as he does with those who generate income for him. When there is a difference in behavior based solely on where the PT offices, that is practicing poor, discriminating, patient care.

  21. John Ware says:

    The answer to your question, Harmony, is that it doesn’t happen anywhere, but it does happen in some PT-owned practices, particularly the large corporate ones where bottom line can distract from vigilant ethical practice.
    The ignorant people I’m referring to would include the PT supervisors that you expressed your concerns to. CMS and independent sources have studied it, and the over-utilization seen in POPTS situations is well-documented. The onsite claim is also a red-herring rationalization for what Sean has decribed.
    Just because the reimbursement system is screwed up doesn’t mean PTs should just continue to “whistle in the dark” as if we are not held to ethical standards. Practicing ethically is an active process that takes effort and vigilance. Knowledge of evidence is one aspect of that.
    I hope you come to realize that soon, and move on from you current situation regardless of what it appears to be on the surface.

  22. Chris says:

    Harmony, in my limited experience (soon to be new grad), volume-based clinics are much more common than I had hoped they were. It seems as though many students are exposed to it on clinical affiliations and as new grads–if they take a position at a facility where the thought process centers around number of units billed and volume of patients seen. Then, the mindset becomes that this is just the way it is and complacency sets in. I’m not sure about the area you are in, but as a new PT grad, I would think you would have numerous options on where you choose to practice. I think complacency is rampant in PT currently (not with those who regularly visit this blog) and I hope that we as a profession are making progress away from the “job with a paycheck” mentality and progressing towards the mentality of a professional practicing with the goal of providing patients with optimal outcomes based on current best practice and striving to find ways to improve our patients’ outcomes. Refuse to become complacent with anything less than optimal pt care practice patterns and refuse to do treatments for the sole purpose of getting billable units. I suggest you find a high-quality practice with motivated clinicians and PT ownership that is focused on pt outcomes and pt satisfaction because I get the feeling from your comments that you desire to practice in this manner and push the profession forward (something you won’t be able to do in this current RFP situation).

  23. It may be of interest to some readers of this blog to read the opinion of an Orthopedic Surgeon David Halsey MD. He spoke on “Adding Ancillary Services to an Orthopedic Practice” at AAOS Practice Management Symposium for Practicing Orthopedic Surgeon in San Francisco. Go to http://www.orthosupersite.com/view.asp?rid=26781

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  25. Fred Heisler says:

    I always come late the party. Atta boy, Paul!
    Fred

  26. Fred Heisler says:

    Whoops. I always come late TO the party. Atta boy, Paul. Keep up the fine work that I know you do.
    Fred

  27. Cyclist Rose says:

    Really? Whore? It’s very disturbing if you put it that way.