Avoiding certification alphabet soup

[jadedphysiotherapist]

Have any practicing therapists felt that the certification designations are straight overkill? Does anyone else feel that the best and most respectable presentation of yourself to the public and referral sources would simply be:

Jadedphysiotherapist, DPT
Board certified pediatrics specialist

Or

Jadedphysiotherapist, DPT
Orthopaedic Specialist
Board Certified

...if multiple for overlap then,


Jadedphysiotherapist, DPT
Neurological and vestibular specialist
Board certified

I know the PT, DPT gets phased out after everyone is licensed with the new curriculum, EBP, outcome measures, pharma and imaging, and specialty coursework, but seriously the NCS, PCS, GCS, OCS, SCS just seems ridiculous to me. It seems so much more humble to have your professions one designation following your name and postgrad training or specialist certification following minimum hour counts in a setting displayed beneath. Interprofessionally, this doesn't look so flashy either.

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[jadedphysiotherapist]

New grads without the hour accumulation for a population:

Jadedphysiotherapist, DPT on cards

or

Jadedphysiotherapist, DPT
Physical therapist

Denoting degree designation and field

 

[DesertPT]

APTA House of Delegates passed a resolution last year that the Association's official policy is now that abbreviations should only be used to represent licensure and earned degrees (eg PT, ATC/L, etc and BSPT, MSPT, DPT, PhD, ScD, etc) and NOT specialty credentials or other certifications (eg NCS, OCS, CSCS, CEEAA, etc etc etc should all be written out underneath your name). Lots of people will take years before they change the way they've been doing it and some never will, but that's the official position:
https://www.apta.org/uploadedFiles/...Licensure/ConsumerProtectionthruLicensure.pdf

Changing the regulatory (legally protected) designator from PT to DPT is not going to happen any time in the remotely near future:
http://www.ptcas.org/uploadedFiles/...Issues/DPT/ChangingtheRegulatorDesignator.pdf

 

[jadedphysiotherapist]

APTA House of Delegates passed a resolution last year that the Association's official policy is now that abbreviations should only be used to represent licensure and earned degrees (eg PT, ATC/L, etc and BSPT, MSPT, DPT, PhD, ScD, etc) and NOT specialty credentials or other certifications (eg NCS, OCS, CSCS, CEEAA, etc etc etc should all be written out underneath your name). Lots of people will take years before they change the way they've been doing it and some never will, but that's the official position:
https://www.apta.org/uploadedFiles/...Licensure/ConsumerProtectionthruLicensure.pdf

Changing the regulatory (legally protected) designator from PT to DPT is not going to happen any time in the remotely near future:
http://www.ptcas.org/uploadedFiles/...Issues/DPT/ChangingtheRegulatorDesignator.pdf

Thats frustrating but a step in the right direction. I wish licensure requirements and continued practice could set a 2020 date to go ahead and make it a requirement so that things become linear as one brand.

As for the second, pharmacy branded the PharmD rather quickly a quarter century ago rather than putting RPh, PharmD. It doesn't seem difficult to do the same thing. Heck, it lets physicians know that you can interpret imaging from a referred patient as well if they are familiar with your curriculum and get respect for each other's services which is starting to occur more with interdisciplinary education

 

[jesspt]

Thats frustrating but a step in the right direction. I wish licensure requirements and continued practice could set a 2020 date to go ahead and make it a requirement so that things become linear as one brand.

As for the second, pharmacy branded the PharmD rather quickly a quarter century ago rather than putting RPh, PharmD. It doesn't seem difficult to do the same thing. Heck, it lets physicians know that you can interpret imaging from a referred patient as well if they are familiar with your curriculum and get respect for each other's services which is starting to occur more with interdisciplinary education

You seem to be very focused on imaging and the role it is going to play in PT practice in a lot of your posts. Currently, many physicians won't interpret imaging - they rely on radiology. Are you so comfortable with your ability to interpret radiographs, MRIs, etc that you would put it in a medical record?

As an aside, there is a big push to reduce the amount of imaging performed, not increase it. I've never been able to order it, and I can't say that I feel like that has negatively impacted my practice.

 

[jesspt]

Thats frustrating but a step in the right direction. I wish licensure requirements and continued practice could set a 2020 date to go ahead and make it a requirement so that things become linear as one brand.

As for the second, pharmacy branded the PharmD rather quickly a quarter century ago rather than putting RPh, PharmD. It doesn't seem difficult to do the same thing. Heck, it lets physicians know that you can interpret imaging from a referred patient as well if they are familiar with your curriculum and get respect for each other's services which is starting to occur more with interdisciplinary education

Also, what would you prefer the professional designation for be for a PT?

 

[jadedphysiotherapist]

You seem to be very focused on imaging and the role it is going to play in PT practice in a lot of your posts. Currently, many physicians won't interpret imaging - they rely on radiology. Are you so comfortable with your ability to interpret radiographs, MRIs, etc that you would put it in a medical record?

As an aside, there is a big push to reduce the amount of imaging performed, not increase it. I've never been able to order it, and I can't say that I feel like that has negatively impacted my practice.

Also, what would you prefer the professional designation for be for a PT?

I'd argue outpatient ordering would be acceptable after X amount of practice hours following licensure. Plenty of fields order that don't have direct training to injury and I see so many therapists in the field using imaging now for references and looking at damage. They aren't doing initial interpretation. That's rads....but you can't get the direct product sent to the person providing the intervention currently in therapy which is odd.

I'd argue degree only behind name. Therapist type beneath the name. Add "Board certified" for subfield credibility. Eliminates alphabet soup. PT, MPT, DPT behind the name until their is a linearity of generational progression to the last brand. Less confusion

 

[jesspt]

I'd argue outpatient ordering would be acceptable after X amount of practice hours following licensure. Plenty of fields order that don't have direct training to injury and I see so many therapists in the field using imaging now for references and looking at damage. They aren't doing initial interpretation. That's rads....but you can't get the direct product sent to the person providing the intervention currently in therapy which is odd.

I'd argue degree only behind name. Therapist type beneath the name. Add "Board certified" for subfield credibility. Eliminates alphabet soup. PT, MPT, DPT behind the name until their is a linearity of generational progression to the last brand. Less confusion

You'd be better off observing PTs who aren't looking at imaging for "damage."
Degree isn't a professional designation. It is a label awarded to a student for an academic achievement.
What about something radical like JessPT, PT.

 

[jadedphysiotherapist]

You'd be better off observing PTs who aren't looking at imaging for "damage."
Degree isn't a professional designation. It is a label awarded to a student for an academic achievement.
What about something radical like JessPT, PT.

I feel like you deal with a lot of LBP and chronic pain patients who don't necessarily have injury that could be borderline surgery or PT so imaging is completely unnecessary in those instances.

The only reason I talk about displaying degree after name is that many schools are having interdisciplinary curriculums and the designation and a specialist title underneath may help with interdisciplinary referral systems as well as just marketing for outpatient

 

[jadedphysiotherapist]

You seem to be very focused on imaging and the role it is going to play in PT practice in a lot of your posts. Currently, many physicians won't interpret imaging - they rely on radiology. Are you so comfortable with your ability to interpret radiographs, MRIs, etc that you would put it in a medical record?

As an aside, there is a big push to reduce the amount of imaging performed, not increase it. I've never been able to order it, and I can't say that I feel like that has negatively impacted my practice.

Also, this is happening across the board in EMRs for this generation. Maybe not initial interpretation, but placing in the medical record and predicting functional deficits and doing differential dx based off of the imaging for issues that develop post stabilization? All the time

 

[jesspt]

Also, this is happening across the board in EMRs for this generation. Maybe not initial interpretation, but placing in the medical record and predicting functional deficits and doing differential dx based off of the imaging for issues that develop post stabilization? All the time

Can you please provide an example?

I'm assuming the last portion of your post indicates that you're looking at imaging of (the many) patients who develop back pain after their lumbar fusion surgery?

 

[sharpieaccent]

I don't see the problem with us being able to order imaging. As long as u get training in it, that should be fine. If you don't want to use imaging, simple don't get trained.

It's a great tool to have, especially for us being msk specialists.

 

[jadedphysiotherapist]

Can you please provide an example?

I'm assuming the last portion of your post indicates that you're looking at imaging of (the many) patients who develop back pain after their lumbar fusion surgery?

No. You look at the initial imaging from fracture or tears. A lot of patients may exaggerate pain as well when the area will actually heal perfectly well since it's a grade 1 ligament tear but they make it seem like the pathology is absurd when you first talk to them. If it's a tear with bloodflow to the area, you can get them better if you can sell therapy well to them. A lot of the imaging from ORIF or fusions is of course available as well. Referencing that quickly isn't bad either since each persons anatomy is slightly different and you want to watch movements that might exacerbate the site (which is one purpose of learning origins and insertions in school. The body is a bunch of pulley systems.).

For neuro, you look at the imaging to see where hemorrhage or trauma to the brain occurred etc. You can be on the lookout for hemianopsia, hemispatial neglect, auditory or cranial nerve deficits, dysmetria, possible flattened affect or depression, apraxia, hypo or hyper metric movements and poor coordination etc. that affect gait, tasks, sequencing in mobility, or may be a fall risk (something therapists can do to decrease "hospital errors")

The therapists are documenting this, then placing the imaging info. original interpretation in EMR to let other disciplines know you've read the initial imaging. You aren't doing the original interpretation. That's radiology.The physicians at good interdisciplinary centers from what I've heard like to know you see this and it helps with follow up if you need to chat outside the door and you've seen something new while they've been balancing new admissions or have been in the OR.

Neurology is too busy injecting tPA and doing medication management and ER is stabilizing. Some of these things get caught after the patient has been initially stabilized and isn't going to pass away. So assessment of the functional deficits on the first eval is a time to catch the neuro issues.

For pulmonary issues, looking at the imaging of their chest helps if you're doing bronchopulmomary segment chest physical therapy so you know how to position correctly. If the patient is complaining of sputum etc. then you can reference the imaging before going in. It helps the patient cough in their own time and breath better and you know the location of the excess sputum secretion before trying to help dislodge it.

 

[jadedphysiotherapist]

Nvm

 

[jadedphysiotherapist]

I don't see the problem with us being able to order imaging. As long as u get training in it, that should be fine. If you don't want to use imaging, simple don't get trained.

It's a great tool to have, especially for us being msk specialists.

*Movement specialists*

More encompassing of all the subfields with that identity

 

[FoamCup]

Nvm

Nvm

dont be like that now lol

 

[jadedphysiotherapist]

dont be like that now lol

I have a problem in which I get too frisky when the conversation and discussion has gotten really educational and informative. Currently, we have an experienced therapist who has been practicing for a while now and I'm letting him know what's going on at the bottom in prep for licensure.

My previous posts were getting off topic and were immature

 

[jesspt]

No. You look at the initial imaging from fracture or tears. A lot of patients may exaggerate pain as well when the area will actually heal perfectly well since it's a grade 1 ligament tear but they make it seem like the pathology is absurd when you first talk to them. If it's a tear with bloodflow to the area, you can get them better if you can sell therapy well to them. A lot of the imaging from ORIF or fusions is of course available as well. Referencing that quickly isn't bad either since each persons anatomy is slightly different and you want to watch movements that might exacerbate the site (which is one purpose of learning origins and insertions in school. The body is a bunch of pulley systems.).

For neuro, you look at the imaging to see where hemorrhage or trauma to the brain occurred etc. You can be on the lookout for hemianopsia, hemispatial neglect, auditory or cranial nerve deficits, dysmetria, possible flattened affect or depression, apraxia, hypo or hyper metric movements and poor coordination etc. that affect gait, tasks, sequencing in mobility, or may be a fall risk (something therapists can do to decrease "hospital errors")

The therapists are documenting this, then placing the imaging info. original interpretation in EMR to let other disciplines know you've read the initial imaging. You aren't doing the original interpretation. That's radiology.The physicians at good interdisciplinary centers from what I've heard like to know you see this and it helps with follow up if you need to chat outside the door and you've seen something new while they've been balancing new admissions or have been in the OR.

Neurology is too busy injecting tPA and doing medication management and ER is stabilizing. Some of these things get caught after the patient has been initially stabilized and isn't going to pass away. So assessment of the functional deficits on the first eval is a time to catch the neuro issues.

For pulmonary issues, looking at the imaging of their chest helps if you're doing bronchopulmomary segment chest physical therapy so you know how to position correctly. If the patient is complaining of sputum etc. then you can reference the imaging before going in. It helps the patient cough in their own time and breath better and you know the location of the excess sputum secretion before trying to help dislodge it.

OK. Fine examples.

Now, if we are sticking to MSK injury and/or pain, do you have good data that suggests that use of imaging facilitates a better outcome for the patient? When should a PT order imaging if they are the first point of contact for a patient who has suffered a severe inversion ankle sprain?

Also, scanning imaging into a patient's chart in an EMR isn't the same as documenting your interpretation of said imaging, which is how I read your initial posts.

 

[jadedphysiotherapist]

OK. Fine examples.

Now, if we are sticking to MSK injury and/or pain, do you have good data that suggests that use of imaging facilitates a better outcome for the patient? When should a PT order imaging if they are the first point of contact for a patient who has suffered a severe inversion ankle sprain?

Also, scanning imaging into a patient's chart in an EMR isn't the same as documenting your interpretation of said imaging, which is how I read your initial posts.

Grade 3s with excess gapping compared bilaterally for that specific question.
Excess edema and fluid buildup and of course a traumatic mechanism of injury rather than an insidious onset as well to make sure it's not a break. If it's fx, then you're not even legally allowed to do procedure so you refer. If it's not fx but someone with Rx or surgical privileges can try to do something that therapy can give the same outcome, then the higher reimbursement rather than conservative tx may get used. I'm not referencing a lot of current outcome literature off hand by look at the marketing campaign "GetPT1st" They are heavy on marketing conservative to to give the same outcome as some surgical procedures

As for pain....differentiate the pathology for the pain type.
You've got muscle produced from positive contraction: No imaging necessary usually
ligament from passive stretch: Depends on severity and elasticity
bone if you happen to be able to have a solid reference like Ottawa rules: Depends on positives
special tests or hx with cardiovascular problems for claudication: Usually refer out but if not sure based on patient response the. Imaging may show its tissue rather than cardiovascular
red flags for immune response induced from underlying pathology or potential for cancer: Just refer out. No imaging needed as tx is not the solution
yellow flags for emotionally driven pain exacerbations requiring perhaps a different clinician: probably not needed
tinel testing or positive paresthesias for a peripheral nerve injury: not needed
dermatomes/myotomes testing together for isolating spine pathology: probably refer out if traumatic moi. Other spine issues that cause pain respond well to manipulation (mobs) with a progression to active exercise

If a special test has good sensitivity and specificity, then go ahead and tx like you normally would....if after a period it isn't working or there are symptoms of other pathology, order to rule out. If surgical or pharmaceutical intervention is necessary, then the patient is inappropriate for physical therapy and refer out.

The problem is that it can get gamed which is why it would have to be regulated well by your board. At the same time, if it's necessary to order something to rule something in or see if the anatomical location has bloodflow, then sure why not. Otherwise the patient hits other contact points who order and Bill but don't treat it and then you're left referencing it on emr following referrals, or the patient gets surgery or excess pharmaceuticals due to how our healthcare system rewards treatments before going to you.

I'd say it's better that therapists have the ability to order and if they receive reimbursement for that then good. If it's overutilized, then they get an audit. It would cost the patient less money having superfluous contact points and having the chance to stay with conservative tx first. It's still better than what it is now.

I also highly doubt therapists would overutilize it like other fields now as well who have no idea how to try differential diagnosis using pain provocation tests and the nature of pain to isolate the pathology yet culture has had patients traditionally go to those fields for 7-15 minute visits. Reference like every urgent care center on the side of the road

 

[jadedphysiotherapist]

OK. Fine examples.

Now, if we are sticking to MSK injury and/or pain, do you have good data that suggests that use of imaging facilitates a better outcome for the patient? When should a PT order imaging if they are the first point of contact for a patient who has suffered a severe inversion ankle sprain?

Also, scanning imaging into a patient's chart in an EMR isn't the same as documenting your interpretation of said imaging, which is how I read your initial posts.

Ah, I see. My apologies. Initial interpretation is always physician turf aka radiologist. Always. However, I would argue like I mentioned above that ordering is warranted and fine in many cases if straight msk Ortho and sports PT.

As for comanages with physicians, it does irk me that we don't have codes for chest physical therapy or on using the neuro imaging to predict neurological deficits that are fall risks or increase dependence for activities. Chest PT isn't used all the time due to lack of coding which is bothersome since it helps patients. Same can be said for neuro differentials. Those are taken from emr, but you use it during the session for prediction.....that is skilled therapy. Period.

With the extra debt, people respond to economic incentives. If skilled things like mentioned above don't receive proper coding, then therapists resort to status quo unit billing rather than more quality interventions.

 

[jesspt]

Grade 3s with excess gapping compared bilaterally for that specific question.
Excess edema and fluid buildup and of course a traumatic mechanism of injury rather than an insidious onset as well to make sure it's not a break. If it's fx, then you're not even legally allowed to do procedure so you refer. If it's not fx but someone with Rx or surgical privileges can try to do something that therapy can give the same outcome, then the higher reimbursement rather than conservative tx may get used. I'm not referencing a lot of current outcome literature off hand by look at the marketing campaign "GetPT1st" They are heavy on marketing conservative to to give the same outcome as some surgical procedures

As for pain....differentiate the pathology for the pain type.
You've got muscle produced from positive contraction: No imaging necessary usually
ligament from passive stretch: Depends on severity and elasticity
bone if you happen to be able to have a solid reference like Ottawa rules: Depends on positives
special tests or hx with cardiovascular problems for claudication: Usually refer out but if not sure based on patient response the. Imaging may show its tissue rather than cardiovascular
red flags for immune response induced from underlying pathology or potential for cancer: Just refer out. No imaging needed as tx is not the solution
yellow flags for emotionally driven pain exacerbations requiring perhaps a different clinician: probably not needed
tinel testing or positive paresthesias for a peripheral nerve injury: not needed
dermatomes/myotomes testing together for isolating spine pathology: probably refer out if traumatic moi. Other spine issues that cause pain respond well to manipulation (mobs) with a progression to active exercise

If a special test has good sensitivity and specificity, then go ahead and tx like you normally would....if after a period it isn't working or there are symptoms of other pathology, order to rule out. If surgical or pharmaceutical intervention is necessary, then the patient is inappropriate for physical therapy and refer out.

The problem is that it can get gamed which is why it would have to be regulated well by your board. At the same time, if it's necessary to order something to rule something in or see if the anatomical location has bloodflow, then sure why not. Otherwise the patient hits other contact points who order and Bill but don't treat it and then you're left referencing it on emr following referrals, or the patient gets surgery or excess pharmaceuticals due to how our healthcare system rewards treatments before going to you.

I'd say it's better that therapists have the ability to order and if they receive reimbursement for that then good. If it's overutilized, then they get an audit. It would cost the patient less money having superfluous contact points and having the chance to stay with conservative tx first. It's still better than what it is now.

I also highly doubt therapists would overutilize it like other fields now as well who have no idea how to try differential diagnosis using pain provocation tests and the nature of pain to isolate the pathology yet culture has had patients traditionally go to those fields for 7-15 minute visits. Reference like every urgent care center on the side of the road

If they use imaging like you have referenced above, they would be over utilizing it. A lot.

 

[truthseeker]

Grade 3s with excess gapping compared bilaterally for that specific question.
Excess edema and fluid buildup and of course a traumatic mechanism of injury rather than an insidious onset as well to make sure it's not a break. If it's fx, then you're not even legally allowed to do procedure so you refer. If it's not fx but someone with Rx or surgical privileges can try to do something that therapy can give the same outcome, then the higher reimbursement rather than conservative tx may get used. I'm not referencing a lot of current outcome literature off hand by look at the marketing campaign "GetPT1st" They are heavy on marketing conservative to to give the same outcome as some surgical procedures

As for pain....differentiate the pathology for the pain type.
You've got muscle produced from positive contraction: No imaging necessary usually
ligament from passive stretch: Depends on severity and elasticity
bone if you happen to be able to have a solid reference like Ottawa rules: Depends on positives
special tests or hx with cardiovascular problems for claudication: Usually refer out but if not sure based on patient response the. Imaging may show its tissue rather than cardiovascular
red flags for immune response induced from underlying pathology or potential for cancer: Just refer out. No imaging needed as tx is not the solution
yellow flags for emotionally driven pain exacerbations requiring perhaps a different clinician: probably not needed
tinel testing or positive paresthesias for a peripheral nerve injury: not needed
dermatomes/myotomes testing together for isolating spine pathology: probably refer out if traumatic moi. Other spine issues that cause pain respond well to manipulation (mobs) with a progression to active exercise

If a special test has good sensitivity and specificity, then go ahead and tx like you normally would....if after a period it isn't working or there are symptoms of other pathology, order to rule out. If surgical or pharmaceutical intervention is necessary, then the patient is inappropriate for physical therapy and refer out.

The problem is that it can get gamed which is why it would have to be regulated well by your board. At the same time, if it's necessary to order something to rule something in or see if the anatomical location has bloodflow, then sure why not. Otherwise the patient hits other contact points who order and Bill but don't treat it and then you're left referencing it on emr following referrals, or the patient gets surgery or excess pharmaceuticals due to how our healthcare system rewards treatments before going to you.

I'd say it's better that therapists have the ability to order and if they receive reimbursement for that then good. If it's overutilized, then they get an audit. It would cost the patient less money having superfluous contact points and having the chance to stay with conservative tx first. It's still better than what it is now.

I also highly doubt therapists would overutilize it like other fields now as well who have no idea how to try differential diagnosis using pain provocation tests and the nature of pain to isolate the pathology yet culture has had patients traditionally go to those fields for 7-15 minute visits. Reference like every urgent care center on the side of the road

What are your thoughts on over radiating people? If the PCP or ortho have already ordered some imaging and you order the same because you simply haven't been able to see it in the record or it was done at a different facility aren't you a little worried that the ordering might become redundant?

 

[truthseeker]

once every two months, maybe, I might make a suggestion for imaging to a PCP.

 

[jadedphysiotherapist]

If they use imaging like you have referenced above, they would be over utilizing it. A lot.

.....really? You think that it would be overutilized more than PCPs and ERs? Use special tests....if it could be a full tear and the literature isn't good on healing timeframes, manual therapy, and exercise for that, then that's a good time to order it yourself.

If direct access is to ever be an actual niche, I really feel that having the autonomy to order when not sure is necessary. Otherwise patients just go to those who have rights but don't treat with tx. They're getting their insurance billed at multiple places and different people ordering who aren't treating msk/ortho

What are your thoughts on over radiating people? If the PCP or ortho have already ordered some imaging and you order the same because you simply haven't been able to see it in the record or it was done at a different facility aren't you a little worried that the ordering might become redundant?

That makes sense. I would think that with emr now, you could just pull it up from the Ortho or PCP if they are referring so it shouldn't get redundant.

If you're competing with them then you'd do it initially obviously.

If it's overutilized then I'd still feel the group would get an audit

once every two months, maybe, I might make a suggestion for imaging to a PCP.

What's wrong with you just doing it? It's your thought process.

 

[jesspt]

.....really? You think that it would be overutilized more than PCPs and ERs?

Well, yes. MSK imaging probably makes up a very small % of a PCP's ordered imaging if they are using evidence-informed practice. The ED is another story...

If direct access is to ever be an actual niche, I really feel that having the autonomy to order when not sure is necessary.

It already is a niche in some practices. I have 3 patients coming in this week via direct access. And I live in a state with a very restrictive practice act.

Imaging can be valuable. But, based on the enthusiasm you seem to have for it, I think you are massively overstating its value in a typical PT practice.

 

[jadedphysiotherapist]

Well, yes. MSK imaging probably makes up a very small % of a PCP's ordered imaging if they are using evidence-informed practice. The ED is another story...


It already is a niche in some practices. I have 3 patients coming in this week via direct access. And I live in a state with a very restrictive practice act.

Imaging can be valuable. But, based on the enthusiasm you seem to have for it, I think you are massively overstating its value in a typical PT practice.

That you for a good comvservation here