Can Physical Therapists Replace Physicians as Primary Care Providers in Hospitals?

Doom-and-gloom futurists project a “doctor shortage” in the United States but new studies increasingly support the roll of non-physician providers in primary care settings, such as hospitals.

A recent study in the December 2011 Health Services Research found that direct access to physical therapists is associated with lower costs and fewer visits and suggests that…

“…the role of the physician gatekeeper in regard to physical therapy may be unnecessary in many cases.”

Patient satisfaction is driven by clinicians who do the following:

  1. spend more time with patients
  2. listen more closely
  3. provide more feedback
  4. show more respect for patients’ opinions

Time spent with the patient AND cultural competency were both factors in a small study presented in June 2011 at the American Academy of Nurse Practitioners (AANP) 26th Annual Meeting in Las Vegas.
The survey of just under 200 patients found that only 50% of physicians’ patients reported that they felt that doctors “always” listened carefully, compared with more than 80% of nurse practicioners patients.

Physicial therapists are trained in listening to patients and in cultural competency. I would like to see this study repeated – comparing physical therapists’ patients to physicians’ patients.

The forces driving increased utilization of non-physician care givers are not just based on quality and licensure. Cost is also causing hospitals to consider nurses, physician assistants and physical therapists in primary care roles.

An October 2011 study in Nursing Economics examined nursing versus physician outcomes over an 18-year period and found the following:

“…patient outcomes of care provided by nurse practitioners and certified nurse midwives in collaboration with physicians are similar to and in some ways better than care provided by physicians alone for the populations and in the settings included.”

This Data Brief from the Centers for Disease Control and Prevention (CDC) shown that, despite regulatory and licensure barriers erected by state medical societies, hospitals are pushing the boundaries of non-physician scope of practice by hiring nurses and physician assistants for primary care roles at increasing rates.

“This analysis shows that visits to Physician Assistants (PA) or Advanced Practice Nurses (APN) have become more common in hospital outpatient departments over the past decade.

…Visits seen only by a PA or APN continue to be higher in rural areas. In addition, a higher proportion of visits to PAs or APNs occur with younger patients.”

The American Physical Therapy Association (APTA) is examining ways that physical therapists can find opportunities in these primary care settings. Listen to this 11-minute podcast called Expectations of a Physical Therapist in the Emergency Department (member log-in required) to learn about expanded practice oppotunities.

The doom-and-gloom futurists have got it wrong, I think. There will NOT be a doctor shortage of the magnitude predicted. If anything, the shortage of physical therapists will only increase.

Now, how do we square THAT circle for my private practice physical therapist brothers and sisters?

Tim Richardson, PT

re-posted from November 28th, 2011