Mark Dutton on the Present and Future of Physical Therapists

Physical therapist Mark Dutton, author of the definitive textbook Dutton’s Orthopaedic Examination, Evaluation, and Intervention and editor-in-chief of AccessPhysiotherapy, recently sat down with McGraw-Hill Education for a talk about the future of physical therapy as a profession, the changes that have taken place over the years in education, training, payment, and the essential role physical therapists play in a patient care team. You can listen to the full conversation here:

Here are some highlights from the podcast:

Physical therapy remains a growing profession

According to Dutton, “There’s still a general level of optimism about the profession, it’s a profession where there’s still a huge demand. Even in places that have several PT schools within the suburban areas, there is still huge demand because you’ve got the different scopes and directions that physical therapists can go into.”

He also points out the advantages physical therapists have in setting their hours. “It’s also a job with a great deal of flexibility you can have, where if you choose home care, you can actually choose the hours that you work and the days that you work and the times that you work. You can basically fit the patients into your schedule. If you don’t like working weekends, you can go for the outpatient setting or the nursing home avenue.”

The money doesn’t hurt either. “In the sort of more rural areas, the pay for therapists is extremely good,” he says. “We do see physical therapists coming out at the age of 21 or 22, often with fairly significant school loans, but it’s still a very good profession to go into.”

Physical therapists engage in significant training

Becoming a physical therapist is more than just being a glorified exercise coach or a massage therapist. Previously physical therapy schools sent students out with a bachelor of science degree at best. But according to Dutton, the American Physical Therapy Association has increased the scope of education, with schools adding APTA’s master’s and doctor of physical therapy programs to their curricula. These expanded curricula offer things such as differential diagnosis, pharmacology, and imaging.

While adding up to two years of study time, the DPT is not a PhD equivalent. “The DPT, or doctor of physical therapy, isn’t a PhD, it’s a term used by the APTA and they make a distinction between that and the traditional PhD,” Dutton says. “You can still get a PhD in physical therapy, but that’s like any other PhD, you go to university and do your various things that they require for a PhD. For the DPT, that’s now the standard curricula that they offer.”

Physical therapists are playing more of a role in diagnosis and determining treatment

As a result of their expanded training, physical therapists are often becoming “the gatekeepers to healthcare,” as Dutton puts it, with physical therapists evaluating whether a patient actually needs PT or needs to be referred for medical treatment.

“Physicians will often send [patients] to the physical therapist first before ordering imaging studies because they know our examination techniques are very thorough and we can often diagnose some of these serious conditions just through a thorough clinical examination including through the patient questionnaire and some of these other tools that we use,” Dutton says.

For example, a physical therapist can determine whether referred pain is musculoskeletal in origin, or is the result of a more serious condition such as a tumor pressing on the nerves, Dutton says.

As a result of the advent of this more evidence-based practice, physical therapists are streamlining the way patients are treated.

“Back in the day it was a shotgun approach, you threw all the tools you had at the patient to try and get them better and it wasn’t necessarily the most efficient way because some of what you were giving probably wasn’t helping and maybe was even slowing down the healing process, where other things were actually helping,” Dutton says. “But it was difficult to determine which ones were helping and which ones weren’t. The push behind evidence-based practice is to weed out those tools that were ineffective and to start using just the ones that bring us the results that we want, that will enhance the patient care so that for one, the patient gets better quicker, and second, we’re able to diagnose the patient quicker as well.”

Physical therapists are becoming part of healthcare systems

Twenty years ago, the ambition of most physical therapists upon graduating was to establish a private practice, Dutton says. That is not the case any longer, a change driven by healthcare reform.

“Now with all the healthcare reform we’ve seen in terms of reimbursement, and the drive for insurance companies to consolidate and move towards a hospital-based or a hospital system-based initiative, that’s driving a lot of these private practices out of business or at least forcing them to align with a hospital system,” Dutton says. “ I think the opportunities for the private practice direction have probably gone away, and it’s going to become rarer, unless you’re a member of one of these national companies that owns private practices. I think there’s going to be more of a drive to people working within these health networks.”

But this can also improve patient care, Dutton points out.

“As a hospital system, you’re providing the full continuum of care, from the in-patient setting where the patient may have had a total hip operation, and then they move to home care or a nursing home, and then from there to an outpatient. So if your therapy system is one continuum, it’s easier for the patient to navigate through, because they know whether they’re going to the hospital as inpatient or to the hospital as outpatient.”

Physical therapists have a lot of patient trust

In an age where patients see their specialists for 15 minutes or less, the 45 minutes or more spent with a physical therapist can be reassuring.

“I think of physical therapists almost like a hairdresser,” Dutton says. “Patients will tell us a lot of things that they won’t tell their own doctor, sometimes they won’t tell their own family member. We tend to be good communicators. Part of the reason why we got into the profession is that we like people, we like treating people, and we spend a lot of time talking to people, so if you’re not a good communicator, you’re not going to last very long in physical therapy.”

As a result of that time and attention, patients feel uplifted. “They actually feel uplifted when they leave and they can’t wait to go back to the next time,” Dutton says. “And it’s not just about the therapists, it’s also the fellow patients who come in at the same time as them and sit on their tables as they’re exercising and talk, it really does become a social event for a lot of patients.”

For more information, please download the white paper Managing Patient Consultations in Physical Therapy.

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