The Scenery Never Changes Unless You Are The Lead Dog

Over the last 20 years I have been practicing in outpatient orthopedics as a physical therapist.  During those 20 years I have had many discussions with colleagues regarding our role as rehabilitation specialists in the medical model with many physical therapists expressing frustration with the model in which they practice.  The primary root of the frustration is the perception that physical therapists don’t have as much influence in patient care as they wish they could.  This has primarily revolved around the topic of direct access and the feeling that direct access will allow physical therapists to have greater influence as it relates to the care of musculoskeletal injuries.  Many physical therapy professionals that I have spoken with over the years have expressed the desire to be first contact practitioners in the management and treatment of musculoskeletal pain and injury.

I couldn’t agree more with the sentiment that we as physical therapists are extremely well positioned to take on the challenge as first contact practitioners for musculoskeletal injuries.  In a time and place where healthcare expenditures continue to rise exponentially, physical therapists have shown time and time again that we are well positioned to tackle this opportunity.  We spend more time with our patients than any other healthcare provider.  We are accessible to patients.  In the grand scheme of things, we are extremely cheap from a cost perspective when compared against other avenues of treatment for musculoskeletal injuries.    The real question that still needs to be answered: Are we ready?

In many cases the same physical therapists who have stated they would like to work in a complete direct access state, also state they get nervous when thinking about this possibility.  In many cases most of the anxiety revolves around whether they feel they are appropriately trained to take on this task.  There is no doubt the level of training has improved over the last 20 years with the advent of the DPT.  The amount and quality of research that has been produced during this time has improved exponentially, and this has again positioned us extremely well to capitalize on this opportunity.  However, there are still a significant number of therapists in the work force who did not complete a DPT.  I can see you all reading this through the computer screen ready to throw daggers at me.  Don’t worry I am not at all indicating that I believe every therapist needs to have a DPT.  There is more to a highly trained physical therapist than just having a degree.  Things such as intuition, wisdom, and experience are also extremely important as well.

That all being said it is high time we all face reality.  We have a huge opportunity in front of us.  My goal in this blog is to try and be a cheerleader.  I admit it’s not my strong suit, but I am more passionate about our profession now more than I ever have been.  I spend a lot of weekends on the road interacting with a tremendous group of highly educated and driven individuals in our profession as I teach continuing education.  I see the patient centered approach that our profession takes in trying to do what’s right for our patients each and every day.  I understand there are some who may feel they don’t have the proper training in medical screening, manual therapy, system reviews, etc. that will enable them to have an improved confidence in capitalizing on the opportunity that is in front of us.  I respect those who consciously self-reflect on their practice working to identify those areas that need to be sharpened or improved.  We all have those areas for sure, and our profession should be one of life long learning.  I urge each one of us to take a look at our own professional development and identify those areas.  I also ask to not only identify those areas, but also to take the next step and work to develop the skill sets needed to become full direct access first contact practitioners.  I firmly believe our medical system and our patients need us now more than ever.  I ask each of us: Are we ready?  Remember the scenery never changes unless you are the lead dog.


One response to “The Scenery Never Changes Unless You Are The Lead Dog

  1. Sheik Abdul khadir A.M.K says:

    Excellent. Nicely written.

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