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CONTEMPORARY
PRACTICE ISSUES
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 Physical therapy, by 2020, will be provided by physical therapists who are

doctors of physical therapy and who may be board-certified specialists.
Consumers will have direct access to physical therapists in all
environments for patient/client management, prevention, and wellness
services. Physical therapists will be practitioners of choice in clients’
health networks and will hold all privileges of autonomous practice.
Physical therapists may be assisted by physical therapist assistants who are
educated and licensed to provide physical therapist–directed and –
supervised components of interventions.
(APTA VISION 2020)

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Contemporary Issues
1. The Doctor of Physical Therapy (DPT) & Post professional DPT
2. Board certification of specialists
3. Direct Access and autonomy
4. Physical Therapist assistants
5. Research
6. Evidence based practice
7. Scope of Practice
 Practice patterns
 Broadening the practice context
8. Political Reaction

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 DPT
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 The professional doctorate is the appropriate degree

for preparation of practitioners who are competent to
meet the broad societal need for physical therapy
services now and in the future.{Clinical Doctorate: A
Framework for Analysis in Physical Therapist Education (A Joseph
Threlkeld, Gail M Jensen and Charlotte Brasic RoyeenThe PHYS THER.
1999; 79:567-581)}

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 DPT provides PTs with a clear professional identity

consistent with that of other health care
professionals (e.g., podiatrists, pharmacists,
psychologists, and chiropractors).
 image of the PT should be consistent with the
public’s expectations of a professional (i.e.,
competence, trust, and autonomy of decision
making) and that the doctoral degree recognizes
and enhances such an image.

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 needs of health care consumers determine not only

the demand or need for physical therapy services
but also social status of physical therapy as a
profession, which in turn would require preparation
at the doctoral level
 Finally, adoption of the professional doctoral
degree would be advantageous in presenting the
professional obligations and responsibilities of PTs

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 DPT: Perspective of the
Profession
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 DPT programs prepare students for the unpredictable future of
clinical practice, which they saw as one in which PTs will be
1. More directly involved in the processes of evaluation,
diagnosis, and patient management
2. Delegating and supervising treatment
3. Writing clinical case reports
4. Documenting the use of outcome data
5. Educating patients, families, students, and peers, as well as
individuals and agencies not directly involved with the
physical therapy profession
6. Confronting ethical and financial dilemmas imposed by
shrinking health care financing.
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 DPT: Perspective of the Practitioner
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 A key issue for the profession is the conversion by 2020 of

licensed PTs with bachelor’s and master’s degrees to PTs with
DPT degrees.
 Having all PTs hold the same degree designation will reduce
the public confusion that arises when the same professionals
hold multiple degrees.
 As PTs become more homogeneous, they will be more easily
identified as the primary providers of care for people with
movement dysfunction
 The ill feeling that might emerge among professionals
regarding the value of an academic degree versus the value of
experience can thus be diverted.
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 The DPT will help eliminate individuals who are

not willing to “go the extra mile” for the
profession.
 The DPT will distinguish PTs from other allied
health practitioners such as massage therapists,
athletic trainers, and kinesiotherapists.

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BOARD CERTIFICATION OF
SPECIALISTS
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 The APTA House of Delegates approved the concept of
specialization in PT practice in 1976, and the requirements for
certification in advanced clinical competence were approved in
1978.
 Appointment of the first nine-member American Board of
Physical Therapy Specialties (ABPTS) followed shortly
thereafter, and subsequently the first specialty council in
cardiopulmonary physical therapy was established, which
developed criteria and a qualifying examination for this
specialty.
 Over the years, specialty councils have been created for
clinical electrophysiology, geriatrics, neurology, orthopedics,
pediatrics, and sports physical therapy.
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Board Certification of Specialities
 Concept of Specialization in PT practice.

Peadiatric
Orthopedic Cardiopulmonary

Specialization Neurology

Integ Sports Geriatrics

 Perspective of the Profession
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 The decision to develop a board of specialization for

PTs was based on the need to formally recognize PTs
with advanced clinical knowledge, experience, and
skills in a specialty area of practice so that they could
be identified by consumers and the health care
community.
 Specialization is believed to promote (1) the highest
possible level of care for individuals seeking physical
therapy services in a specialty area and (2) the
development of the science and art underlying the
specialty.
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 Most physicians seek board certification as

specialists; will a similar trend develop for PTs?
 What are the implications if those who choose to
specialize come to outnumber those who do not?
 Will PTs identify more with their specialization
group than with the general profession?
 Will specialization generate competing
professional organizations of PTs as the number
certified in each specialty grows
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 What impact will increased specialization have on

health care costs and quality of care?
 Given the ever-expanding knowledge base, can
PTs continue to be generalists?
 Can specialization thrive under managed care,
with its emphasis on efficiency?
 Does an alternative mechanism for advancement
exist for PTs who are not interested in the
administrative career path?
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 DIRECT ACCESS
 Perspective of the Profession
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 “Direct access is the ability of a physical therapist to provide
evaluation and treatment to patients without the need for a
physician referral.”
 The public is best served when access is unrestricted.
 The primary rationale for this position is that direct access
eliminates the burden of unnecessary visits to physicians to obtain
physical therapy services, which can result in delays and denial of
services provided by PTs.
 The delays in care result in increased costs, decreased functional
outcomes, and patient frustration.
 PTs believe that their extensive education and clinical training
make them well qualified to practice without referral, at no
increased risk to their patients’ health, safety, 04/20/2024
and welfare
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 These practice acts are typically discussed in terms

of those that place no restrictions on physical
therapists in the evaluation and/or treatment of
patients without a physician’s referral and those
that do have restrictions.
 For example, many jurisdictions allow the PT to
perform only an evaluation initially; the patient
then must be referred to a physician, who must
approve the PT’s plan of care before it can be
implemented.
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 Objections to direct access included (1) the belief

that education of PTs was not sufficient to allow
them to serve as initial contacts for entry into the
health care system; (2) the risk that serious medical
problems might be missed in systems other than the
musculoskeletal system; and (3) the fear that
increasing the autonomy of PTs would shift them to
private practice and create staffing shortages in
hospitals

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 DIRECT ACCESS
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 Perspective of the Practitioner

 Some PTs want direct access others don't??
 Lack of knowledge and skills
 Not willing to take full responsibility
 Happy with referral system
 May be number of patients/client reduce

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 PHYSICAL THERAPIST ASSISTANTS
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 Physical therapy is defined as the care and service provided by or under the
direction and supervision of a physical therapist.
 Physical therapists are the only professionals who provide physical therapy.
 Physical therapist assistants—under the direction and supervision of the
physical therapist—are the only paraprofessionals who assist in the
provision of physical therapy interventions.
 Examination, evaluation, diagnosis, and prognosis should be represented
and reimbursed as physical therapy only when they are performed by a
physical therapist.
 Intervention should be represented and reimbursed as physical therapy only
when performed by a physical therapist or by a physical therapist assistant
under the direction and supervision of a physical therapist.

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 PHYSICAL THERAPIST ASSISTANTS
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 The PTA is a technically educated health care provider who

assists the PT in the provision of physical therapy.
 In the contemporary provision of physical therapy services,
the PT is considered the professional practitioner of physical
therapy, and the PTA, educated at the technical level, is
considered the paraprofessional.
 These definitions specify the exclusivity of the term physical
therapy (often phrased as, “It’s only physical therapy if a
physical therapist does it”) and then extend the term’s use to
include services provided by PTAs under the direction and
supervision of the PT.

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 THE GUIDE—AN EXTRAORDINARY
ACHIEVEMENT
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 By arangments of FPTA, Contributions from more

than 600 experts in various fields were fine tuned
and integrated, and in 1997 the Guide to Physical
Therapist Practice was published. (Its current title
is the Interactive Guide to Physical Therapist
Practice with Catalog of Tests and Measures.This
publication has come to be known simply as “the
Guide.”

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The Guide serves the following
purposes in the profession:
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i. Describes PT practice in general
ii. Describes the roles of PTs in primary, secondary, and tertiary care; prevention; and
promotion of health, wellness, and fitness
iii. Describes the settings in which PTs practice
iv. Standardizes the terminology used in and related to PT practice
v. Establishes the tests and measures, as well as interventions, used in PT practice
vi. Delineates preferred-practice patterns to help PTs accomplish the following
vii. Improve the quality of care
viii. Enhance the positive outcomes of physical therapy services
ix. Enhance patient satisfaction
x. Promote appropriate use of health care services
xi. Increase efficiency and reduce unwarranted variation in the provision of services
xii. Diminish the economic burden of disablement through prevention of poor health
practices and promotion of health, wellness, and fitness initiatives
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 Scope of Practice
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shahidheera@gmail.com 04/20/2024
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shahidheera@gmail.com 04/20/2024
 THE APTA /PPTA AND POLITICAL ACTION
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 Political Action Committee

 The Physical Therapy Political Action Committee
(PT-PAC) states that its purpose is to “ensure that
physical therapy maintains a forceful voice in the
halls of Congress.”

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Thanks
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