Primary Care Specialty in PT? Is Now the Time?

Primary Care.

It is a phrase often heard within the medical field, but is now getting more buzz within physical therapy.  With the trending shortage in physician primary care, is this the time to develop a specialty practice within physical therapy?

Over the past year or so, I have had the privilege to work with an outstanding group of individuals within the PT profession along with APTA staff to determine the feasibility of developing a primary care speciality within PT.  The process has been painstaking and has allowed for much debate, discussion and future thinking.

We are at the point now where the APTA is currently developing a Description of Specialty Practice (DSP) in Primary Care moving toward an ABPTS recognized specialty. In order to do this, APTA needs input!  A survey has been created that lays out components of the DSP in Primary Care and will help validate (or not) the DSP.

The survey will be released in the next few weeks.

If you have experience or strong feelings about primary care within PT, this survey is for you.

Are you involved with health promotion and wellness initiatives? We need your input!

Do you practice in a rural setting and see many different kinds of conditions and patients? Fill out the survey.

If you have thoughts on the name of this specialty (i.e. Is ‘Advanced General Practitioner’ a better name for the specialty?) – fill out the survey.

Do you work in the emergency department as a PT?  Fill out the survey.

You get my point here.  Now is the time to make your voice heard.

The data from this survey will be extremely valuable in the development of the DSP for this potential specialty going forward!

If you are willing to participate, you can email Hadiya Guerrero at hadiyaguerrero@apta.org or Jeannie Bryan Coe at jbryancoe@mindspring.com.  If you have questions regarding the developing specialty, please contact Jeannie.

@ShepDPT

9 responses to “Primary Care Specialty in PT? Is Now the Time?

  1. Tim Mondale says:

    Mark,

    What would be the definition of “Physical Therapy Primary Care”? I’ve heard this term throughout the years from Chiro’s, and now us, and I’ve never understood what is meant. If we’re talking about first access to aches and pains then I get it (also called direct access). Surely we’re not talking about colds, flu’s, and illness; medicine etc…?

    Please enlighten me.

    Tim

    1. Mark Shepherd says:

      Yes – we are not talking colds, flus, etc. The group has envisioned this for folks with aches and pains, but also for other patient populations (pediatric, emergency medicine, wellness, etc.)

  2. Jeannie Bryan Coe says:

    Thanks for your comment Tim. We are primarily talking first access to pnts with aches and pains and other things in the PT wheelhouse. NOT colds, flu, etc.

    1. Tim Mondale says:

      Mark and Jeannie,
      Thanks for your responses. First let me say, I think our profession is ready and capable of and for direct access, and we should at the national organizing and legislative level pursue that with all we have. Patients, and our health care system deserve us as that option.

      However to this point I don’t see how this subspecialty title would benefit us in any way, and I could see how it would potentially cause conflict with our medical colleagues.
      We need to continue to work on branding ourselves as the best first choice for aches, pains, functional limitations, health and wellness.

      1. Steven Spoonemore says:

        Tim,
        I agree with the sentiment that we should continue branding ourselves as the best 1st choice for aches, pains, etc. Direct access care in a stand-alone outpatient clinic is one option for patients. However, the reality that only a small portion of patients with aches and pains ever enter the care of a PT, direct access or via referral. Childs et al and Fritz et al looking at 2 different population-level studies found dismal rates in the teens for patients who actually were in the care of a PT for musculoskeletal complaints. The reality is that more than 1/2 of the U.S. population seeks care for these conditions from the medical system, whether a primary care doc or the ever-growing trend of urgent care and emergency departments. We can continue to brand ourselves and sit on the street corner waiting for the patient to do the right thing and come to us, or we can go to where the patients are.

        For those of us who practice in rural settings where there are limited healthcare resources, PT’s have an incredible opportunity to be valuable assets to their community. Our unique training as movement experts can transcend and incorporate itself into so many aspects of healthcare. For the last two years I practiced in a small rural community with incredibly high rates of obesity, diabetes, domestic violence and suicide. I practiced right alongside the primary care providers as an integral part of the primary care team. In some instances, I was the lead provider–practicing in a “direct access” role. In many other instances, I was a consultant and guide addressing movement based problems as part of a comprehensive plan for the patient. My role would vary from:
        * identifying and addressing fall risks in the elderly population,
        *screening and examination and treatment of athletes and workers for a return to sport/work
        *pain science education, basic health literacy education
        *health coaching and encouragement
        *traditional PT exam and treatment
        *splinting for suspected acute fractures (we had no x ray capabilities in our facility–we stabilized the patient and sent them to the hospital 25 miles away for further treatment)
        *Nutrition, sleep hygeine and lifestyle factor modification
        *Any many more…

        The primary care providers, nurses and other clinical staff I worked with absolutely embraced having the expertise of a highly trained PT on their team. There were instances where disagreements on the best treatment course (ie when imaging and referral to Orthopedics/Spine surgeon would occur) but by walking the walk and demonstrating solid outcomes for patients, the confidence of the team and utilization of my skills continued to grow. My experience is that Primary Care Providers are desperate to find help in addressing chronic pain and routine aches, pains and wellness. They simply are overburdened with the complexity of our healthcare infrastructure and demands on their time to spend the time that we often can give to addressing these issues. I have had multiple primary care providers tell me something to the effect, “any musculoskeletal problem is yours, you are better qualified to care for it, let me know if the patients need any additional workup”

        PT’s working in the ED perform in a very similar way and hospitals that utilize PT’s in the ED consistently report very high patient and provider satisfaction rates. Let me be clear I am not an advocate for Physician owned or Hospital system owned PT practices, there must be a peer to peer relationship, not a boss to employee relationship in order for the patients to receive the best care.

        An autonomous practitioner practices interdependently. As a profession, we need to become comfortable with working alongside and with other members of the healthcare community. People are continually looking for the advise and care we that are skilled to provide, I agree that we need to get our message out there and bring the patients into our clinics. We also need to go where the people are to provide the service.

  3. Mark says:

    I would say no way are PT’s coming out of most DPT programs ready for this. The schools are going to have to do a better job at real world prep and learning what it means to be a professional.

  4. Hey Mark,

    Great article on physical therapy and primary care practice. I am really torn on this one: I see the benefit of PT in primary care, but improved direct access (especially in states that don’t have it) is what will make us frontline providers. It will allow us to screen for medical issues that need to be directed to a PCP for follow-up. This is especially important for those who do not see/have a PCP. I do not think a primary care specialty adds any value to what we already have.

    There are huge benefits to having a PT present on an ER unit. However, in this setting, more specialty training is needed (ex. knowing how to do post mold splints for various fractures, etc.). The ER technicians do this very well; unfortunately, we never learned how to do this in school (as PTs we should be experts with this, in my opinion). They also handle the vast majority of assistive device training, which is something PTs are vastly superior at. I have had to correct a number of techs on gait training, stair-climbing, assistive devices, etc.).

  5. Good and helpful article on physical therapy. Quite informative.

  6. Tim Mondale says:

    #fullmedicaredirectaccessorbust; let’s not take our eyes off the ball.

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