PT Practice Acts!
Hopefully, most U.S. readers of this newsletter are aware of the evolving PT scope of practice issue. If not, here's a brief summary.
In 2001, the APTA published a 2nd edition of the Guide to Physical Therapist Practice. This Guide:
"more clearly defines scope of practice; guides patterns of practice; improves quality of care; promotes appropriate use of health care services; and explains physical therapist practice to insurers, policymakers, and other health care professionals"
In and of itself, The Guide does not define the profession's scope of practice. The Guide, however, does provide States with "model language" to be used for drafting State practice acts which then serve to legally define a profession's scope of practice within their domain of concern.
The new APTA guidelines greatly expand PT's domain of concern to include the following: functional training in self care and in home, community or work integration. Most readers recognize that training in these areas has been the traditional domain of other professions, including occupational therapy. While al professions, including OT, expand their practice domains over time, their is a limit as to what any profession can legitimately claim as theirs. While some PT authors have argued that the above areas are "traditional" domain for the PT profession, as aptly put by the AOTA:
"The education, training and practice of physical therapy does not support extension of their scope in the manner proposed [functional training in self care and in home, community or work integration] without recognizing the inherent limits in physical therapy training and preparation in these areas"
From: AOTA, PT Scope Fact Sheet
This limits are clearly illustrated by Chuck Wilmarth (AOTA) in a recent e-mail message to the Florida OT Association List Serve:
"An article in PT Magazine addressing physical therapy intervention with Parkinson's disease [discusses] the patient's functional limitations in daily activities more narrowly confined to addressing the need for improvement in 'flexibility, balance control and movement organization.'"
The AOTA is taking a stand against the expanding of PT's practice areas by providing State OT organizations with its own version of suggested model language to be used in PT practice acts. The AOTA model provides two different language recommendations:
The first recommendation would be to suggest that the phrase "functional training in self care and in home, community or work reintegration" be deleted from any proposed legislation.
Or, if this is not successful {i.e. not accepted by the State PT agency} then add wording such as "testing individuals with mechanical, physiological and developmental impairments, functional limitations in physical movement and mobility.
The key to the second suggestion is that the emphasis is placed on PT treating 'functional limitations' only as it relates to physical movement and mobility.
While these approaches MAY be successful, I am concerned that this is the beginning of something very ominous. If the PT Practice Guidelines are used as promotional tools to physicians, providers and consumers then may people are going to be left thinking that PT's are experts in function and mobility. With the tremendous media exposure, name recognition and clout possessed by the PT profession, we are facing what may turn out to be an tremendous challenge to our professional integrity.
Unfortunately, the problem goes even deeper than legislation. Least you think that the PT profession is not promoting themselves as "daily living" experts, here is a short expert from the APTA Consumer Information web page
Today, Betty is back in her garden. The skills she learned from her physical therapists allow her to maneuver through the uneven ground of her backyard. She has the strength to stand on both legs without a walker or a cane and pull dead vines from her morning glories. She can even carry the garden hose to water her vegetables. 'I feel so blessed that I had that therapy,' she says"
While this may seem like a 'doom and gloom' message, there is a light at the end of tunnel. Of course, it is up to each of us to search for and find that light. I hope that future issues of this newsletter will indirectly provide both motivation and direction on how occupational therapy can keep in place its unique contribution to health care.
This newsletter strives to serve the interests of the occupational therapy community in the promotion and enhancement of the practice of occupational therapy.