Podiatrist offers "in house physical therapy"

[jesspt]

I think that the average physician knows how to look for certain things but may not have a great explanation for everything that is seen when it comes to MRI. In addition, defensive medicine is a practice that we are often forced to practice which does not help with utilization...that's beside the point.

I'll contact the APTA about that number of PTs employed by POPTs. It would be interesting to know.

In my own experience, I personally like having PTs in house out of convenience of communication and patient care. Having worked at a PT clinic throughout college, I used to hate the disconnect between providers. It drove me (and likely you guys as well) crazy!

Fozzy,

My point regarding the data about physician ownership of MRI is that the data shows that once they own an MRI, their use of imaging goes up. Being the owner of an MRI doesn't mean that you understand the interpretation of the picture any better. It is likely that these practitioners are influenced by $omething other than the patient'$ best intere$t.

Do I think the average physician knows more about MRI that they do about PT? Yup. Do I think that lack of understanding is the primary variable when it comes to tendency towards increased utlization once a physician offers an in-house service? Nope, because we see it happen with PT, with imaging; two dissimilar services with one primary thing in common - the referring provider makes $$$ off of the service.

I'll see if I can't hunt that reference down again. I think I posted it in the Pain medicine forum when I had the audacity to suggest that POPTs was a referral for profit situation and a conflict of interest. That was right before someone told me that is wan't "Pro-patient" and was probably likely just burning through the Medicare cap and then handing the patient a TENS unit at a significant mark-up just prior to discharge.

I'm sure you participate in meaningful discourse with the PTs to whom you refer patients. Having talked to PTs who work for physicians, and having worked for an ortho group in my PT youth, I can tell you that that is more of a rarity than you might think. And, since I've moved to a different setting, I've never had any real difficulty getting ahold of a physician to discuss a case when needed.

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[jesspt]

And Fozzy,

I certainly am not attacking you. I'm actually glad we have some physician representation on this thread, particularly one with your insights.

 

[fozzy40]

You guys are much more familiar with the data than I am. Every field has its group of bad apples. I'm curious to know if all POPT clinics overutilize or are these just outliers. Believe me, I see what you guys are saying.
My issues:

1) The premise of this whole argument is that it paints physicians as incapable of being unethical. I don't like to be prejudged and neither do any of you.
2) This does encroach upon who is "allowed" to employ PTs. Hospital employed physicians don't direct money from referring to PTs but we do get "suggestions" or "pressure" to refer to our own resources versus a competitor across the street. This is the same in my mind.
3) No one forces a PT who works for a POPT to work there and/or receive compensation. As the other poster said, people need jobs and willing to do what they need to do. An ethical issue we all deal with. I just had a patient receiving therapy once per/week for the past 6 months. When I talked with the PT I asked what goals are they hoping to achieve with that plan. They admitted that this was a person of influence in the community and basically they keep renewing the script. Who is responsible? The prescribing physician or the treating PT.

Just more food for thought...

 

[jesspt]

You guys are much more familiar with the data than I am. Every field has its group of bad apples. I'm curious to know if all POPT clinics overutilize or are these just outliers. Believe me, I see what you guys are saying.

I don't think they all overutilize. I'm not even sure the majority do.
My issues:

1) The premise of this whole argument is that it paints physicians as incapable of being unethical. I don't like to be prejudged and neither do any of you.

I think you're mistating the argument here, or I have misrepresented it. I don'tt think that physicians are incapable of acting in an ethical fashion. The vast majority of them take their ethical responsibilities very seriously. However, physicans are human, and can succomb to the same kind of pressures that anyone else can when placed in a situation where there may be an ethical dilema. If that situation were unavailable, at least that pressure would be gone.

2) This does encroach upon who is "allowed" to employ PTs. Hospital employed physicians don't direct money from referring to PTs but we do get "suggestions" or "pressure" to refer to our own resources versus a competitor across the street. This is the same in my mind.
I know that this type of thing happens from my days when I worked in a hospital based outpatient PT clinic. I'm not sure what the solution is here, becuase I think that much of this pressure comes from administration. At the very lease, I would hope that there is a disclaimer on hte PT order, or the patient's intake paperwork that states somthing similar to what is required to be on a PT order from a physician who owns a PT clinic - something like "Although Healthsystem XYZ provides rehabilitation services, you are free to choose a provider outside of our system."

3) No one forces a PT who works for a POPT to work there and/or receive compensation. As the other poster said, people need jobs and willing to do what they need to do. An ethical issue we all deal with.

Agreed. I do not think that POPTs is just a physician issue.

I just had a patient receiving therapy once per/week for the past 6 months. When I talked with the PT I asked what goals are they hoping to achieve with that plan. They admitted that this was a person of influence in the community and basically they keep renewing the script. Who is responsible? The prescribing physician or the treating PT.

Just more food for thought...

I wonder if they were billing the patient's insurance. I'm not sure I would have an issue with this if the patient was self-pay.

 

[jesspt]

Some more data on self referral and strain it places on an already stressed health care system:

http://www.sacbee.com/2012/11/01/4955550/alliance-for-integrity-in-medicare.html

 

[Ferocity]

I suggest every single PT or PT student on this website submit a formal complaint against these "doctors" as I have.

Cumberland Foot and Ankle centers of Kentucky
http://www.somersetfootdocs.com/services.html

Kentucky state law:
327.020 License required -- Exceptions -- Use of designation or name
[FONT=Arial,Arial][FONT=Arial,Arial]
(1) No person shall practice or hold himself out as being able to practice physical therapy in any manner whatsoever unless he meets the educational requirements of this chapter, is licensed in accordance with the provisions of this chapter, he is in good standing with the board and his license is not suspended or revoked.
..

Complaint Form:
http://pt.ky.gov/NR/rdonlyres/4FAC0970-E6DF-45A9-8564-3CD2B50C4423/0/COmplaintForm.pdf

Did a DPT really just call a podiatrist a "doctor"?

Wow.

 

[kptnau]

I know a PT who works at a Skilled Nursing Facility. She didn't mention having more patients than she should, but she didn't like that her employers were trying to get her to do more time per patient when it wasn't always appropriate. Many 90 year-old patients can't take an hour of PT and an hour of OT every day.
This is similar to your debate. The business is trying to earn more money despite the lack of need for more therapy. The PT feels pressured to provide more care just to make her employer happy.
POPTS will definitely have an option to do illegal things. Many will take the option.
Who wants to do PT for a podiatrist anyways? Sounds awful boring and you probably get lots of gross feet.

 

[Fiveoboy11]

Did a DPT really just call a podiatrist a "doctor"?

Wow.

Average undergrad GPA of PT student matriculants within PTCAS schools: 3.52
Average undergrad GPA of DPM student matriculants within AACPM schools: unknown average, but on this link it gives average stats by school. The averages are: 3.51, 3.23, 3.27, 3.26, 3.21, 3.41, 3.3, 3.21, 3.3. Of those averages, the average is 3.3.

Further, I like how the podiatry and chiropractic professions constantly try to compare and equalize themselves to the medical professionals (DO/MD), with the "podiatric physician" or "podiatric medical school." Is there a single podiatry school that is at a public institution. Looking at the list of podiatry schools, it looks very similar to chiropractic educational institutions, both isolate themselves and can't get into the "mainstream" yet want to equalize themselves and then mock professions like mine. For example, by employing a PT with a snap of the finger, and "ordering" physical therapy to make up for botched surgeries left and right, writing lame articles urging other podiatrists to make money off of the physical therapy profession. See links in other posts and this from wikipedia even which clearly states within it that podiatrists "order and perform physical therapy."

As a PT, I have received numerous referrals from podiatrists, which is fine at that point. But, I have to admit that I have not been impressed by the outcomes or the efficacy of the surgeries/interventions that are performed on the average. It is certainly nowhere near the benefit of say a TKA, or a rotator cuff repair. I would say many are in the league with lumbar fusions.

Here's a link of the most recent minutes from the state of AZ podiatric "examiners" which goes into detail of about four or so botched procedures/surgeries. Wouldn't be surprised if these will have a negative effect on those respective patients for the rest of their lives.

FYI, I do think podiatrists are doctors, but I do not buy for a second that the podiatry profession is anywhere near the PT profession in terms of efficacy of interventions and quality of their professionals/schooling.

My question to you is, what in the world are you laughing at from the perspective of objective thought?

 

[facetguy]

Further, I like how the podiatry and chiropractic professions constantly try to compare and equalize themselves to the medical professionals (DO/MD), with the "podiatric physician" or "podiatric medical school." Is there a single podiatry school that is at a public institution. Looking at the list of podiatry schools, it looks very similar to chiropractic educational institutions, both isolate themselves and can't get into the "mainstream" yet want to equalize themselves and then mock professions like mine. For example, by employing a PT with a snap of the finger, and "ordering" physical therapy to make up for botched surgeries left and right, writing lame articles urging other podiatrists to make money off of the physical therapy profession. See links in other posts and this from wikipedia even which clearly states within it that podiatrists "order and perform physical therapy."

I think this is where much of your resentment toward other professions comes from. Be happy with the fact that yours is a well respected profession with a proven track record, along with the fact that over your career as a PT you will help many people. You get all torn up over not being able to order diagnostic tests or employee a DPM/DC/MD/whatever or being thought of as a doctor. Focus on the positive, unless you plan to harbor lots of anger and bitterness for the rest of your career. Do good work and you'll get the respect you're looking for.

 

[MaxillofacialMN]

Further, I like how the podiatry and chiropractic professions constantly try to compare and equalize themselves to the medical professionals (DO/MD), with the "podiatric physician" or "podiatric medical school." Is there a single podiatry school that is at a public institution. Looking at the list of podiatry schools, it looks very similar to chiropractic educational institutions, both isolate themselves and can't get into the "mainstream" yet want to equalize themselves and then mock professions like mine. For example, by employing a PT with a snap of the finger, and "ordering" physical therapy to make up for botched surgeries

Not to call you out, but what is wrong with you? You literally just said you "like" how podiatry is apparently not a legitimate profession... How can someone like the fact that 15000 doctors should not be practicing? Like seriously, the goal here is patient care. You should honestly be ashamed of yourself for taking joy in 15k people's (according to you) misfortune...

 

[Fiveoboy11]

I think this is where much of your resentment toward other professions comes from. Be happy with the fact that yours is a well respected profession with a proven track record, along with the fact that over your career as a PT you will help many people. You get all torn up over not being able to order diagnostic tests or employee a DPM/DC/MD/whatever or being thought of as a doctor. Focus on the positive, unless you plan to harbor lots of anger and bitterness for the rest of your career. Do good work and you'll get the respect you're looking for.

I'm sorry but you're wrong. First, I have zero interest in "employing" any other professional. At best I would be interested in a partership with a professional of the same or different discipline, with extreme focus on patient care and zero focus on improving the bottom line or any other business centered practice. Second, I truly do not recall a single point in my career where I thought :: gee it'd sure be nice to order an x-ray :: I do believe PT's should be able to order x-rays when it is actually appropriate (i.e. not to look for subluxations or malalignments, or ordering them for every single patient that comes through the door) but little to none of my resentment is related to this. Third, I do not care about being thought of or called a doctor by patients. I have never introduced myself as one (I prefer to make the patient comfortable vs tower over them). However, it is important to me for other professionals to recognize that PT's are now receiving a doctorate right out of school. I receive referrals from a very nice MD where I'm currently working who refers to himself by his first name with his patients, very admirable and shamefully rare if you ask me. Not coincidentally, he doesn't write PT "orders" or write lame commentary on "scripts" either. I wonder if patient's appreciate that they can talk to this physician as a person. I wonder how much potential is lost due to the "white coat effect" ?

Finally, I do not agree that it is best to just focus on the positive. I think it is best to do the right thing, and push for change. People who do what you say will always stagnate.

 

[Fiveoboy11]

Not to call you out, but what is wrong with you? You literally just said you "like" how podiatry is apparently not a legitimate profession... How can someone like the fact that 15000 doctors should not be practicing? Like seriously, the goal here is patient care. You should honestly be ashamed of yourself for taking joy in 15k people's (according to you) misfortune...

I do not "like" it at all, that was taken out of context and you know it. I guess what I meant is that it is illegitimate for podiatry to try and "big time" the physical therapy profession or to "equalize" themselves with the DO/MD professionals.

 

[fozzy40]

I think this is where much of your resentment toward other professions comes from. Be happy with the fact that yours is a well respected profession with a proven track record, along with the fact that over your career as a PT you will help many people. You get all torn up over not being able to order diagnostic tests or employee a DPM/DC/MD/whatever or being thought of as a doctor. Focus on the positive, unless you plan to harbor lots of anger and bitterness for the rest of your career. Do good work and you'll get the respect you're looking for.

 

[dyk343]

MaxillofacialMN is a pre-pod who has been running rampant on other boards lately stirring things up. We apologize for this. He has good intentions as some inflammatory material has been posted but stirring the pot is never a good idea. (Sorry Max I still like you but...)

I am a 3rd year podiatry student. I still have a lot to learn, but I personally refer patients out at least once a day, often more to PT. I truly believe it is a great career as patients come back and state how much the physical therapy has helped. I've seen it time and time again.

Hopefully the OP really does not feel the way he feels about podiatry. Sure there are some bad practitioners out there but the same can be said for any of the health professions. I encourage everyone to explore podiatry more and what we offer to patients, as we will be working together a lot in our careers.

Best of luck to all. Feel free to PM me if you have any questions regarding podiatry.

 

[Ferocity]

Average undergrad GPA of PT student matriculants within PTCAS schools: 3.52
Average undergrad GPA of DPM student matriculants within AACPM schools: unknown average, but on this link it gives average stats by school. The averages are: 3.51, 3.23, 3.27, 3.26, 3.21, 3.41, 3.3, 3.21, 3.3. Of those averages, the average is 3.3.

Further, I like how the podiatry and chiropractic professions constantly try to compare and equalize themselves to the medical professionals (DO/MD), with the "podiatric physician" or "podiatric medical school." Is there a single podiatry school that is at a public institution. Looking at the list of podiatry schools, it looks very similar to chiropractic educational institutions, both isolate themselves and can't get into the "mainstream" yet want to equalize themselves and then mock professions like mine. For example, by employing a PT with a snap of the finger, and "ordering" physical therapy to make up for botched surgeries left and right, writing lame articles urging other podiatrists to make money off of the physical therapy profession. See links in other posts and this from wikipedia even which clearly states within it that podiatrists "order and perform physical therapy."

As a PT, I have received numerous referrals from podiatrists, which is fine at that point. But, I have to admit that I have not been impressed by the outcomes or the efficacy of the surgeries/interventions that are performed on the average. It is certainly nowhere near the benefit of say a TKA, or a rotator cuff repair. I would say many are in the league with lumbar fusions.

Here's a link of the most recent minutes from the state of AZ podiatric "examiners" which goes into detail of about four or so botched procedures/surgeries. Wouldn't be surprised if these will have a negative effect on those respective patients for the rest of their lives.

FYI, I do think podiatrists are doctors, but I do not buy for a second that the podiatry profession is anywhere near the PT profession in terms of efficacy of interventions and quality of their professionals/schooling.

My question to you is, what in the world are you laughing at from the perspective of objective thought?

Why do you begrudge the podiatric medical education and have so much resent towards our talented physicians and surgeons?

 

[Fiveoboy11]

Why do you begrudge the podiatric medical education and have so much resent towards our talented physicians and surgeons?

As soon as your outcomes improve first and foremost, secondly your fellow podiatrists stop trying to control and own physical therapy, and lastly your student statistics improve, I will respect your education and talent.

 

[Ferocity]

As soon as your outcomes improve first and foremost, secondly your fellow podiatrists stop trying to control and own physical therapy, and lastly your student statistics improve, I will respect your education and talent.

How can you be a sound judge of patient outcomes when you are neither a physician or surgeon?

 

[Fiveoboy11]

How can you be a sound judge of patient outcomes when you are neither a physician or surgeon?

Because I'm a physical therapist and I've seen many post op podiatry surgeries. I've seen some that have made patient's far worse with unrelenting and chronic pain. PT's are easily qualified to judge an outcome post operatively, thanks for making your ignorance more obvious, good thing you're still a student.

 

[Ferocity]

Because I'm a physical therapist and I've seen many post op podiatry surgeries. I've seen some that have made patient's far worse with unrelenting and chronic pain. PT's are easily qualified to judge an outcome post operatively, thanks for making your ignorance more obvious, good thing you're still a student.

Have you seen many post op surgeries performed by foot and ankle trained orthopedic surgeons?

Please elaborate on your qualifications to judge post operative outcomes. Are you trained in surgical techniques? I'd like to learn more about my physical therapist peers seeing as how they are an important asset for both the patient and physician. Thank you.

 

[fozzy40]

Out of curiosity, are DPMs lumped into the POPT data?

 

[Fiveoboy11]

Have you seen many post op surgeries performed by foot and ankle trained orthopedic surgeons?

Please elaborate on your qualifications to judge post operative outcomes. Are you trained in surgical techniques? I'd like to learn more about my physical therapist peers seeing as how they are an important asset for both the patient and physician. Thank you.

I have seen achilles rupture repair, talocrural fusion, talonavicular fusion (yikes), bunionectomies, cheilectomies, 1st MTP jt replacement, partial plantar fasciectomy, peripheral nerve decompressions, fracture ORIF, lateral ankle ligament repairs and revisions, bla bla. Probably lots of others but I can't think of them. Obviously I've seen lateral ankle sprains, high ankle sprains, tarsal tunnel syndrome/posterior tibialis dysfuction, mid foot sprains, bla bla.

Difference in ortho surgeon at foot/ankle vs podiatrist, good question. The foot/ankle surgeries I've seen (minus achilles repair and talocrural fusion) have been by DPM's. Achilles repairs generally do quite well but take forever to rehab, fusions at the talocrural usually will be pain free eventually but obviously with motion restriction.

PT's are experts with regard to outcomes post operatively after MSK surgeries because we rehabilitate them all day long, and understand a good outcome relative to the surgery and the patient. We work all day long to help the patient achieve a good outcome so stop wasting time thinking we don't know what a good outcome is.

 

[Ferocity]

I have seen achilles rupture repair, talocrural fusion, talonavicular fusion (yikes), bunionectomies, cheilectomies, 1st MTP jt replacement, partial plantar fasciectomy, peripheral nerve decompressions, fracture ORIF, lateral ankle ligament repairs and revisions, bla bla. Probably lots of others but I can't think of them. Obviously I've seen lateral ankle sprains, high ankle sprains, tarsal tunnel syndrome/posterior tibialis dysfuction, mid foot sprains, bla bla.

Difference in ortho surgeon at foot/ankle vs podiatrist, good question. The foot/ankle surgeries I've seen (minus achilles repair and talocrural fusion) have been by DPM's. Achilles repairs generally do quite well but take forever to rehab, fusions at the talocrural usually will be pain free eventually but obviously with motion restriction.

PT's are experts with regard to outcomes post operatively after MSK surgeries because we rehabilitate them all day long, and understand a good outcome relative to the surgery and the patient. We work all day long to help the patient achieve a good outcome so stop wasting time thinking we don't know what a good outcome is.

I was just simply asking you some questions so I could learn more about physical therapy. Why are you being so abrasive?

Also why did you refer to a podiatrist as "doctor"? I though that was somewhat funny seeing as how integral the relationship between a podiatric physician and physical therapist is.

 

[PADPM]

Because I'm a physical therapist and I've seen many post op podiatry surgeries. I've seen some that have made patient's far worse with unrelenting and chronic pain. PT's are easily qualified to judge an outcome post operatively, thanks for making your ignorance more obvious, good thing you're still a student.

Your comments are simply biased not to mention insulting. I've been in practice for quite a few years (well over 20) and have an incredible relationship with several local PTs. I can assure you their experience with podiatric surgery differs greatly.

I have performed surgery on many patients as a result of a "referral" from these PTs and have performed surgery either on members of the family of these PTs or actually on the PT. A PT who moved out of the area sent her mother to see me for surgery.

I'm confident that wouldn't be the case if they viewed my surgical outcomes as less than acceptable.

There are good and bad podiatrists, just as there are good and bad PTs, dentists, etc. Maybe the patients you are seeing with less than optimal outcomes are simply not talented surgeons. Maybe you just don't have the best podiatrists referring to your practice. Maybe they are only sending patients who aren't healing well and are experiencing complications. Maybe the patients who are doing well haven't needed your services.

We can all regurgitate anecdotal stories of an incompetent professional. My friend is a well respected orthopod who hesitates to ever send post op hip/knee replacements to PT since many of his patients have experienced severe complications secondary to over aggressive PT. I can talk about countless episodes of disasters caused by some incompetent PTs, but that doesn't mean I don't still refer to competent PTs.

As far as your comment regarding witnessing many bad podiatric surgical outcomes, I'm SURE you've never seen any poor surgical outcomes from an orthopedic surgeon, general surgeon, neurosurgeon, etc.

You also say that you won't respect podiatry until outcomes improve, please provide me with data that there is an overall dis-satisfaction with surgical outcomes. Those studies don't exist, and that's why my colleagues and I perform a LOT of surgery via satisfied patient referrals and perform a lot of surgery on patients returning for surgery on the opposite foot.

As far as podiatrists trying to "control" PT, that comment is so ridiculous that it isn't even worth a reply.

But the real point is that you simply don't like podiatry, period. Maybe you're bitter that podiatry can admit patients to the hospital and you can't. Maybe it bothers you that podiatry now has to complete a minimum of 3 years of residency training. Maybe it upsets you that podiatrists can write prescriptions and you can't. Maybe it bothers you that podiatrists can perform surgery in the hospital and you can't.

Or maybe you simply resent the profession for some deep seated irrational reason.

Regardless, I have a lot of happy PTs in my area who regularly get referrals from our practice and who often recommend our services to friends and family.

You are smart enough to know that there are many excellent podiatrists. Don't lower yourself by insulting an entire profession. Be happy and proud of your chosen profession without having to trash another. It reflects poorly on you.

 

[Fiveoboy11]

Your comments are simply biased not to mention insulting. I've been in practice for quite a few years (well over 20) and have an incredible relationship with several local PTs. I can assure you their experience with podiatric surgery differs greatly.

I have performed surgery on many patients as a result of a "referral" from these PTs and have performed surgery either on members of the family of these PTs or actually on the PT. A PT who moved out of the area sent her mother to see me for surgery.

I'm confident that wouldn't be the case if they viewed my surgical outcomes as less than acceptable.

There are good and bad podiatrists, just as there are good and bad PTs, dentists, etc. Maybe the patients you are seeing with less than optimal outcomes are simply not talented surgeons. Maybe you just don't have the best podiatrists referring to your practice. Maybe they are only sending patients who aren't healing well and are experiencing complications. Maybe the patients who are doing well haven't needed your services.

We can all regurgitate anecdotal stories of an incompetent professional. My friend is a well respected orthopod who hesitates to ever send post op hip/knee replacements to PT since many of his patients have experienced severe complications secondary to over aggressive PT. I can talk about countless episodes of disasters caused by some incompetent PTs, but that doesn't mean I don't still refer to competent PTs.

Tell me in detail about the disasters caused by PT's. Your orthopod friend doesn't know what he's doing if he doesn't send especially the post op TKA patient's to a PT, generally anterior approach THA don't need it anyway, s/p THA generally do though. I've never had a problem with a post op THA or TKA. I sincerely look forward to your stories. I agree that everyone can spew out anectdotes, but I want to hear yours.

As far as your comment regarding witnessing many bad podiatric surgical outcomes, I'm SURE you've never seen any poor surgical outcomes from an orthopedic surgeon, general surgeon, neurosurgeon, etc.

I said many times the poor outcomes that are common s/p lumbar fusion, but to be quite honest I cannot think of others right off the top of my head that commonly have bad outcomes performed by orhopods/neurosurgeons.

You also say that you won't respect podiatry until outcomes improve, please provide me with data that there is an overall dis-satisfaction with surgical outcomes. Those studies don't exist, and that's why my colleagues and I perform a LOT of surgery via satisfied patient referrals and perform a lot of surgery on patients returning for surgery on the opposite foot.

I do not have studies to cite, but I will look. My personal experience is that post surgical outcomes at the foot/ankle done by pods is not very good.

As far as podiatrists trying to "control" PT, that comment is so ridiculous that it isn't even worth a reply.

But the real point is that you simply don't like podiatry, period. Maybe you're bitter that podiatry can admit patients to the hospital and you can't. Maybe it bothers you that podiatry now has to complete a minimum of 3 years of residency training. Maybe it upsets you that podiatrists can write prescriptions and you can't. Maybe it bothers you that podiatrists can perform surgery in the hospital and you can't.

Nope, I like being a PT, but I don't think I could convince you of that since (as you've said) I can't do surgery, write prescriptions, etc.

Or maybe you simply resent the profession for some deep seated irrational reason.

Regardless, I have a lot of happy PTs in my area who regularly get referrals from our practice and who often recommend our services to friends and family.

Do those happy PT's also own the practice that you refer to? Or is there an incentive for them to tell you they appreciate the referrals?

You are smart enough to know that there are many excellent podiatrists. Don't lower yourself by insulting an entire profession. Be happy and proud of your chosen profession without having to trash another. It reflects poorly on you.

Sorry about that, I'm sure there are many excellent podiatrists out there.

 

[Fiveoboy11]

I was just simply asking you some questions so I could learn more about physical therapy. Why are you being so abrasive?

Also why did you refer to a podiatrist as "doctor"? I though that was somewhat funny seeing as how integral the relationship between a podiatric physician and physical therapist is.

Because that podiatrist owns a PT clinic (inappropriate) and was advertising that physical therapy was performed "in clinic" which if you ask me is misleading to people who read it as it implies that the podiatrist and his/her staff provide physical therapy. I don't care for the minimizing of physical therapy or PT's as professionals with this walmartization. Add that to the fact that the same podiatrist wrote an article detailing how a podiatrist could "provide" physical therapy to make more money.

 

[PADPM]

Sorry about that, I'm sure there are many excellent podiatrists out there.

You are correct. There are many excellent podiatrists out there, and unfortunately some who suck. Similar to any profession.

Disasters caused by PTs----- a PT telling my post op surgical patient that it was okay to transition out of a walking cast into a sneaker even though I gave the patient strict orders to stay in the boot.

A PT who did not read my RX for gentle ROM exercises following an Achilles repair and ripped the crap out of the repair and performed Graston type PT on the patient 3 weeks after surgery.

A PT who told my patient I was "wrong" regarding a limb length discrepancy that was confirmed by an orthopod and specialized radiographic techniques, and caused a lot of problems for,the patient when the PT gave the patient a heel lift for the long limb.

A PT who told the patient that they should continue treatments for Achilles' tendon pathology even though the patient came to me for a second opinion and I felt the patient had a DVT, not a tendon pathology. And venous Duplex Doppler ultrasound confirmed my diagnosis.

A PT who told a patient that he had gout since there was edema and erythema and the patient actually had ascending cellulitis with a fever of 102.

Those are a few of my anecdotal stories. Want more? I've been in practice a long time and I've got a great memory.

And yes, the PTs who I refer to DO own their own practices. But I doubt they would refer friends or family to me for surgery just to retain my referrals.

But my entire point is that be happy with what you do without trashing what I do. It's unfortunate that some of your experiences with pods haven't been great, but I assure you there are plenty/the majority doing great work.

 

[Fiveoboy11]

You are correct. There are many excellent podiatrists out there, and unfortunately some who suck. Similar to any profession.

Disasters caused by PTs----- a PT telling my post op surgical patient that it was okay to transition out of a walking cast into a sneaker even though I gave the patient strict orders to stay in the boot.

This is pretty dumb, I always follow post op WB precautions.

A PT who did not read my RX for gentle ROM exercises following an Achilles repair and ripped the crap out of the repair and performed Graston type PT on the patient 3 weeks after surgery.

Ripped the crap out of the repair? You mean it re-ruptured? Or the patient had soreness, and had a f/u with you, and since you think PT's are your orderlies you extrapolate that to "ripped the crap out of the repair."

A PT who told my patient I was "wrong" regarding a limb length discrepancy that was confirmed by an orthopod and specialized radiographic techniques, and caused a lot of problems for,the patient when the PT gave the patient a heel lift for the long limb.

You think a PT should automatically agree with every single thing you say? Again, PT's are not your assistants, or orderlies. We do our own assessment and act accordingly. Are you saying the PT told the patient to put a heel lift in the shoe of the longer leg because it appeared that it was shorter, or did the PT tell him/her to put it in the opposite side and the patient misinterpreted? Was the patient malingering, catastrophizing? This is not a disaster. Recommending to a patient that they try a heel lift is not remotely close to a disaster and so unlikely to cause long term problems especially if the person has above a 60 IQ and takes the heel lift out, you know when they are having worsening pain.

A PT who told the patient that they should continue treatments for Achilles' tendon pathology even though the patient came to me for a second opinion and I felt the patient had a DVT, not a tendon pathology. And venous Duplex Doppler ultrasound confirmed my diagnosis.

The PT was wrong, this actually does approach a disaster. However, are you sure the DVT was present at the time the PT saw the patient? A DVT patient's develop is not present at birth, and thus one you see subsequent to a PT visit does not mean the PT was wrong, or missed it. But, I do see what you're saying. This was potentially a major flub.

A PT who told a patient that he had gout since there was edema and erythema and the patient actually had ascending cellulitis with a fever of 102.

Cellulitis is easy to spot and could never be confused with gout by anyone who can see with their eyeballs. If this is true, and the same S/S were present as when you saw them, then this PT is a *****.

Those are a few of my anecdotal stories. Want more? I've been in practice a long time and I've got a great memory.

Yes, I would like to read as many as you have, I could give lots of anectdotes regarding patient's post podiatric surgery that I guess at this point would be classified as a supercalifradgilisticexpialodosious disaster since they had devastating effects (i.e. intractable pain, severe difficulty in walking, etc).

And yes, the PTs who I refer to DO own their own practices. But I doubt they would refer friends or family to me for surgery just to retain my referrals.

Fair enough

But my entire point is that be happy with what you do without trashing what I do. It's unfortunate that some of your experiences with pods haven't been great, but I assure you there are plenty/the majority doing great work.

I am happy with what I do, but am very unhappy with the "system" so to say. I do not think it is appropriately run specifically with regard to PT/PT's.

I also want to say that I think many professionals who typically have direct access or primary care roles feel that PT's are ROM/strengthening/script following monkeys. We are not. We do our own evaluation and develop the POC and educate/recommend things to the patient based upon what we feel is best for them. If that is in contradiction to what someone such as yourself thinks, it does not mean the PT caused a disaster. Are we wrong sometimes? Sure, does it cause a real disaster? Very rare.

 

[MaxillofacialMN]

MaxillofacialMN is a pre-pod who has been running rampant on other boards lately stirring things up. We apologize for this. He has good intentions as some inflammatory material has been posted but stirring the pot is never a good idea. (Sorry Max I still like you but...)

Haha, no need to apologize. I'm not a *****, I know what I am posting and how I am posting it. I love the internet!

If you want to apologize, you can apologize for the "lately" business. I've been running rampant on these boards for years!

 

[PADPM]

I am happy with what I do, but am very unhappy with the "system" so to say. I do not think it is appropriately run specifically with regard to PT/PT's.

I also want to say that I think many professionals who typically have direct access or primary care roles feel that PT's are ROM/strengthening/script following monkeys. We are not. We do our own evaluation and develop the POC and educate/recommend things to the patient based upon what we feel is best for them. If that is in contradiction to what someone such as yourself thinks, it does not mean the PT caused a disaster. Are we wrong sometimes? Sure, does it cause a real disaster? Very rare.

You perplex me. You ask for examples as if you doubt my sincerity, and then you make excuses for the PT.

First of all, don't put words in my mouth or speak for me. Don't even think about attempting to insult me personally, since you know nothing about me or my philosophy. I have NEVER even implied that I treat PTs as orderlies. Never. If that's an insecurity you have, that's a problem you have to work out.

On my first example YOU admit that the PT was "pretty dumb", and it's something you would not have done. But you asked for an example and I responded.

On my second example, yes, the PT ripped the crap out of the repair and I had to bring the patient back to surgery. The repair was solid post op and I have a diagnostic ultrasound to confirm that one day prior. This resulted in a lawsuit against the PT that settled out of court.

On my third example, you are once again grabbing at straws. I don't expect or want a PT to be a monkey. But the PT was provided with copies of my notes, the orthopod notes and radiological results. So you can't turn the tables that the patient was in error. It was plain and simple and documented in the PT notes.

On my third example,,the PT simply messed up and missed the diagnosis. I'm not going to start attempting to make excuses for her error.

On my fourth example, you agreed and actually called the PT a "*****".

So, you asked for examples and I provided valid examples. Now you want more? Are you kidding? Sorry, I don't have the time to start listing every negative encounter with a PT. And if I listed ten more, you'd wouldn't be satisfied because your head is in the sand.

The sad part is that you missed the entire point. I STILL regularly refer to PTs and respect their skills. I ALWAYS write my preferences, the diagnosis and goals when prescribing PT, and also add that other treatment should be provided as per the evaluation. I ask that if a recommendation contradicts my RX, that I receive a call to discuss the case.

You make excuses for many of my examples and even tried to blame the patient for the errors of the PT. I can turn the tables and ask you if maybe the patient was to blame for all these poor surgical outcomes you see. Did the patient follow all the post op instructions, was the patient non compliant, etc., etc. I did NOt make these excuses. There are some bad surgeons, but I can assure you there are far more excellent surgeons.

My point is and was that you can't trash an entire profession due to a few bad apples.

You are preaching to the choir. I have NO problem with PTs or what they do or their scope of practice. You trashed my profession and I defended it. You asked for examples of issues I've had with PT and I provided examples. However, I never trashed your profession and continue to refer to PT.

I don't degrade an entire profession based on a few less than competent practitioners. Can you say the same?

 

[jesspt]

Out of curiosity, are DPMs lumped into the POPT data?

If you mean the investigation performed by the Office of the Inspector General, then no. And, I'm not sure that any of the POPTs studies I have looked at include DPMs.

 

[jesspt]

Maybe I can provide a little context about the DPM - PT relationship from the PT side of things (without sounding reactionary).

All of the previous statements about good DPMs & bad DPMs, good PTs & bad PTs are, of course, correct. ALL professions have excellent clinicians and very poor ones, and most probably sit somewhere in the middle of that bell curve.

Rule number one when rehabbing a patient who has had surgery - PROTECT THE INTEGRITY OF THE REPAIR/RECONSTRUCTION!!! Once a patient has been operated on, I think that surgeon "owns" that outcome, and if they don't want me to pursue ROM beyond a certain point, or defer strengthening exercises beyond the usual time frame, I assume they have a pretty good reason for doing so.
Now, if they don't want me to pursue first ray plantar flexion, the patient ends up with metatarsus elevatus, and they want to make me their whipping boy for the poor ROM, that I would take issue with. It should be noted that this latter scenario RARELY happens.

If it isn't a post-op case, I view the PT referral as a consultation, where I examine the patient and, using best available evidence, determine what interventions within my scope of practice may be of benefit to the patient. This information is then communicated verbally to the patient during their first session, and to the referring provider via a faxed or emailed note highlighting the examination findings from a PT perspective, as well as the PT plan of care.

Fiveoboy - I know you think your passion about PT is helpful, but you continue to alienate other professionals on this board. I would love it if you could harness and channel this energy into meaningful communication about the benefits that physical therapy can have for many of the patients that are commonly seen by other health care providers. I think you could really help propel our profession forward. But, at this point, your communication style is so astringent and abrasive that I don't see how anyone could ever respond to you with anything other than a defensive reply. Some words of advice: Assume the best of intentions of your customers/clients/referral sources and start givign some other providers the benefit of the doubt.

 

[Fiveoboy11]

You perplex me. You ask for examples as if you doubt my sincerity, and then you make excuses for the PT.

First of all, don't put words in my mouth or speak for me. Don't even think about attempting to insult me personally, since you know nothing about me or my philosophy. I have NEVER even implied that I treat PTs as orderlies. Never. If that's an insecurity you have, that's a problem you have to work out.

As below, if you're trying to direct the PT POC, then that is evidence that you think of PT's as orderlies. It's not an insecurity, it's recognition of reality. Are you a PT?

On my first example YOU admit that the PT was "pretty dumb", and it's something you would not have done. But you asked for an example and I responded.

On my second example, yes, the PT ripped the crap out of the repair and I had to bring the patient back to surgery. The repair was solid post op and I have a diagnostic ultrasound to confirm that one day prior. This resulted in a lawsuit against the PT that settled out of court.

On my third example, you are once again grabbing at straws. I don't expect or want a PT to be a monkey. But the PT was provided with copies of my notes, the orthopod notes and radiological results. So you can't turn the tables that the patient was in error. It was plain and simple and documented in the PT notes.

Screw you, I was trying to clarify. I would never take your word for it.

On my third example,,the PT simply messed up and missed the diagnosis. I'm not going to start attempting to make excuses for her error.

On my fourth example, you agreed and actually called the PT a "*****".

So, you asked for examples and I provided valid examples. Now you want more? Are you kidding? Sorry, I don't have the time to start listing every negative encounter with a PT. And if I listed ten more, you'd wouldn't be satisfied because your head is in the sand.

The sad part is that you missed the entire point. I STILL regularly refer to PTs and respect their skills. I ALWAYS write my preferences, the diagnosis and goals when prescribing PT, and also add that other treatment should be provided as per the evaluation. I ask that if a recommendation contradicts my RX, that I receive a call to discuss the case.

To me, this is evidence that you try to control/dictate physical therapy. The physical therapist determines the physical therapy goals. The physical therapist recommends the POC. PT's do this funny thing called an initial evaluation and then base the Rx on that, not on your referral, recommendations, or preferences. Does that not make sense to you? Do you really think writing ROM/strengthening does something? Do you really think you rival a PT in post op rehab and if not why in the world are you infecting your thoughts/recommendations into the case when the things you write are probably obvious anyway?

You make excuses for many of my examples and even tried to blame the patient for the errors of the PT. I can turn the tables and ask you if maybe the patient was to blame for all these poor surgical outcomes you see. Did the patient follow all the post op instructions, was the patient non compliant, etc., etc. I did NOt make these excuses. There are some bad surgeons, but I can assure you there are far more excellent surgeons.

The intent was not to make excuses but to clarify.

My point is and was that you can't trash an entire profession due to a few bad apples.

You are preaching to the choir. I have NO problem with PTs or what they do or their scope of practice. You trashed my profession and I defended it. You asked for examples of issues I've had with PT and I provided examples. However, I never trashed your profession and continue to refer to PT.

I don't degrade an entire profession based on a few less than competent practitioners. Can you say the same?

Your disasters are less than impressive. I have no doubt that you yourself have screwed up with far more devastating effects than all those PT's combined. That doesn't make you incompetent. I'm sure I have screwed up a time or two with devastatingly disastrous effects (i.e. minor temporary side effects) but I don't think I'm incompetent.

 

[Fiveoboy11]

Fiveoboy - I know you think your passion about PT is helpful, but you continue to alienate other professionals on this board. I would love it if you could harness and channel this energy into meaningful communication about the benefits that physical therapy can have for many of the patients that are commonly seen by other health care providers. I think you could really help propel our profession forward. But, at this point, your communication style is so astringent and abrasive that I don't see how anyone could ever respond to you with anything other than a defensive reply. Some words of advice: Assume the best of intentions of your customers/clients/referral sources and start givign some other providers the benefit of the doubt.

I truly appreciate your feedback and I think a lot of what you say is correct. I disagree with you that a surgeon "owns" a repair, the patient owns the repair. I highly highly doubt any surgeon would better be able to determine the post-operative rehabilitation progression as far as PT goes than you could, and thus it makes no sense to follow some lame protocol or directives as scibbled on some tiny piece of paper. I'm 100% confident that PT's directing the post-op POC in all respects is best for the patient's far and away. Not even close. What do we all think about control over ones profession vs reliance on another, gee I surely wonder which method would produce the most knowledgable and competent/expert practitioners.

 

[Ferocity]

I truly appreciate your feedback and I think a lot of what you say is correct. I disagree with you that a surgeon "owns" a repair, the patient owns the repair. I highly highly doubt any surgeon would better be able to determine the post-operative rehabilitation progression as far as PT goes than you could, and thus it makes no sense to follow some lame protocol or directives as scibbled on some tiny piece of paper. I'm 100% confident that PT's directing the post-op POC in all respects is best for the patient's far and away. Not even close. What do we all think about control over ones profession vs reliance on another, gee I surely wonder which method would produce the most knowledgable and competent/expert practitioners.

Out of curiosity, do you direct these same sentiments towards all physicians or just podiatric physicians?

 

[Fiveoboy11]

Out of curiosity, do you direct these same sentiments towards all physicians or just podiatric physicians?

It has nothing to do with being a physician. If a insurance company, NP or PA or business owner tried to direct PT I would say the same things. For example, one clinic I worked in had a "clinic manager" who disputed my D/C of a s/p MVA patient after I was made aware that he had upwards of 60 visits of PT within the past 6 mo or so. I flipped and she was fired the very same day. You see, if a person objects to stupidity there will be change over time. If one sits idly by and puts up with it, it'll never change. Fascinatingly enough there's lots of people with chronic MSK conditions and chronic pain.

It makes no sense for another profession to try to direct and control another, especially when it is a profession of very high quality, abundant evidence, etc. If you disagree, why don't you try to rehabilitate some of your patient's post op and see how great you are, since it's so easy as to scribble on a piece of paper to direct what to do. As soon as I come across a bonehead as above who's not a physician I'll rip into them as hard as I can too and with every last bit of fury I have. Stay tuned.

 

[PADPM]

Your disasters are less than impressive. I have no doubt that you yourself have screwed up with far more devastating effects than all those PT's combined. That doesn't make you incompetent. I'm sure I have screwed up a time or two with devastatingly disastrous effects (i.e. minor temporary side effects) but I don't think I'm incompetent.

1). Hone up on your reading comprehension.

2). You have some serious inferiority issues. Yes, I write my goals of PT because many insurance carriers require that information AND the PTs I refer to ask for that information. If that ruffles your insecure feathers, seek counseling.

3). Don't start delving into my surgical results and I won't delve into your results. You can't have a mature conversation without slinging insults. You asked me for examples, I gave them and then you go off on a tangent about MY outcomes. That has nothing to do with my comments. They were simple. You wrote about podiatric screw ups and I wrote about PT screw ups.

4). Screw me????? Really. When you stoop that low you prove your lack of professionalism and just lost the argument. Your credibility has just gone to zero.

5). Take the advice of your colleague and stop making enemies.

6). You amaze me that it pisses you off that docs write goals or a requested treatment plan. If that pisses you off or harbors resentment, you're in the wrong field. You should be happy that anyone would send you a patient.

I'm done. I can't use rational reasoning with someone irrational.

 

[PADPM]

Maybe I can provide a little context about the DPM - PT relationship from the PT side of things (without sounding reactionary).

All of the previous statements about good DPMs & bad DPMs, good PTs & bad PTs are, of course, correct. ALL professions have excellent clinicians and very poor ones, and most probably sit somewhere in the middle of that bell curve.

Rule number one when rehabbing a patient who has had surgery - PROTECT THE INTEGRITY OF THE REPAIR/RECONSTRUCTION!!! Once a patient has been operated on, I think that surgeon "owns" that outcome, and if they don't want me to pursue ROM beyond a certain point, or defer strengthening exercises beyond the usual time frame, I assume they have a pretty good reason for doing so.
Now, if they don't want me to pursue first ray plantar flexion, the patient ends up with metatarsus elevatus, and they want to make me their whipping boy for the poor ROM, that I would take issue with. It should be noted that this latter scenario RARELY happens.

If it isn't a post-op case, I view the PT referral as a consultation, where I examine the patient and, using best available evidence, determine what interventions within my scope of practice may be of benefit to the patient. This information is then communicated verbally to the patient during their first session, and to the referring provider via a faxed or emailed note highlighting the examination findings from a PT perspective, as well as the PT plan of care.

Fiveoboy - I know you think your passion about PT is helpful, but you continue to alienate other professionals on this board. I would love it if you could harness and channel this energy into meaningful communication about the benefits that physical therapy can have for many of the patients that are commonly seen by other health care providers. I think you could really help propel our profession forward. But, at this point, your communication style is so astringent and abrasive that I don't see how anyone could ever respond to you with anything other than a defensive reply. Some words of advice: Assume the best of intentions of your customers/clients/referral sources and start givign some other providers the benefit of the doubt.

Well stated.

 

[Fiveoboy11]

1). Hone up on your reading comprehension.

2). You have some serious inferiority issues. Yes, I write my goals of PT because many insurance carriers require that information AND the PTs I refer to ask for that information. If that ruffles your insecure feathers, seek counseling.

3). Don't start delving into my surgical results and I won't delve into your results. You can't have a mature conversation without slinging insults. You asked me for examples, I gave them and then you go off on a tangent about MY outcomes. That has nothing to do with my comments. They were simple. You wrote about podiatric screw ups and I wrote about PT screw ups.

4). Screw me????? Really. When you stoop that low you prove your lack of professionalism and just lost the argument. Your credibility has just gone to zero.

5). Take the advice of your colleague and stop making enemies.

6). You amaze me that it pisses you off that docs write goals or a requested treatment plan. If that pisses you off or harbors resentment, you're in the wrong field. You should be happy that anyone would send you a patient.

I'm done. I can't use rational reasoning with someone irrational.

I have a doctorate in physical therapy, thus I'm the doctor with regard to physical therapy with my patient's and I think it's time you and your ignorant collegues embrace that. You know little to nothing about physical therapy (because you're not a PT) and thus any goals or guidelines you provide are baseless and worthless, regardless of who requires it or requests it. That is nothing more than antiquated garbage. I did not want to become a podiatrist but could have easily got into the school since 3/4 of the flipping applicants do. I prefer to see a much wider array of NMSK conditions, but am intolerant to the system that you advocate for and think "works" although the healthcare industry is bankrupting this country.

I'm confident that my reading comprehension is better than yours, I went to PT school, not podiatry school. I didn't have a 2.75 undergrad GPA. Inferiority complex? More of a intolerance to BS complex.

 

[PADPM]

I have a doctorate in physical therapy, thus I'm the doctor with regard to physical therapy with my patient's and I think it's time you and your ignorant collegues embrace that. You know little to nothing about physical therapy (because you're not a PT) and thus any goals or guidelines you provide are baseless and worthless, regardless of who requires it or requests it. That is nothing more than antiquated garbage. I did not want to become a podiatrist but could have easily got into the school since 3/4 of the flipping applicants do. I prefer to see a much wider array of NMSK conditions, but am intolerant to the system that you advocate for and think "works" although the healthcare industry is bankrupting this country.

I'm confident that my reading comprehension is better than yours, I went to PT school, not podiatry school. I didn't have a 2.75 undergrad GPA. Inferiority complex? More of a intolerance to BS complex.

Your bitterness and anger are so evident in your posts it's amazing. I assure you that you're doing yourself a dis-service by making any attempt to question my academic abilities. But once again you generalize as if I'm exactly equal to every applicant.

After over 25 years in practice, I can assure you that I know plenty about physical therapy. That's simply an idiotic statement that I know "little or nothing about PT". That's as ignorant as me saying you know little or nothing about the foot and ankle.

And yes, keep patting yourself on the back a d you may need PT for a rotator cuff injury. Of course you know more about PT than I do, you've got a friggin' doctorate. But why do you constantly have to tell us that? Isn't it intuitive that a PT knows more about therapy than anyone else?

What's with all the anger when a doctor lets you know HIS/HER goals for PT, or asks you to take it easy on a post op patient. The radiologist doesn't get all pissed off when I recommend a study and provide a pathology to be ruled out.

Your issues are deep. Instead of pounding your chest and reminding them that YOU are the almighty DPT and they should leave it all up to you, you should graciously accept their referrals and realize that any goals of treatment or recommendations are NOT ill intended or meant to insult. You're just so damned insecure you can't accept that fact.

Apparently you have an authority issue and taking instructions or recommendations from anyone drives you looney.

I've got you pegged. You were that kid that got beat up all the time when you were little. Now you are bitter.

On a side note, I had a good friend who is a DPT and teaches at a very well known PT program read your comments. He was embarrassed to have you in the profession and assured me that your feelings are not the "norm".

The amazing part is you rant and rave but don't address the issues. Keep trashing podiatry, it will get you far in life. And just by your posts I can assure you that you're not in my league academically. You've got a lot of catching up to do........

Now why don't you take your medication, seek some anger management counseling and take the advice of your colleagues to be more diplomatic.

And I'd love to hear from other PTs if you get as crazed when any doctor writes an RX with goals or recommendations. After all, it doesn't indicate the doctor thinks he knows more than you, it's just a recommendation.

 

[Ferocity]

It has nothing to do with being a physician. If a insurance company, NP or PA or business owner tried to direct PT I would say the same things. For example, one clinic I worked in had a "clinic manager" who disputed my D/C of a s/p MVA patient after I was made aware that he had upwards of 60 visits of PT within the past 6 mo or so. I flipped and she was fired the very same day. You see, if a person objects to stupidity there will be change over time. If one sits idly by and puts up with it, it'll never change. Fascinatingly enough there's lots of people with chronic MSK conditions and chronic pain.

It makes no sense for another profession to try to direct and control another, especially when it is a profession of very high quality, abundant evidence, etc. If you disagree, why don't you try to rehabilitate some of your patient's post op and see how great you are, since it's so easy as to scribble on a piece of paper to direct what to do. As soon as I come across a bonehead as above who's not a physician I'll rip into them as hard as I can too and with every last bit of fury I have. Stay tuned.

I noticed that you put clinic manager in quotations. Do you feel that clinic managers are impeding on the profession of a physical therapist? Perhaps their title should be changed to something else, such as "clinic coordinator" or "clinic advisor". Do you think "managers" bark out too many "orders" in general?

Thanks again for your valuable input as I learn more about the physical therapy profession.

 

[PADPM]

I've decided that it isn't fair to bore anyone with any more in this thread. Therefore, if there are any comments or concerns, please feel free to send me a private message. That will allow for a hopefully mature "offline" discussion, rather than back and forth bickering.

 

[Fiveoboy11]

Your bitterness and anger are so evident in your posts it's amazing. I assure you that you're doing yourself a dis-service by making any attempt to question my academic abilities. But once again you generalize as if I'm exactly equal to every applicant.

After over 25 years in practice, I can assure you that I know plenty about physical therapy. That's simply an idiotic statement that I know "little or nothing about PT". That's as ignorant as me saying you know little or nothing about the foot and ankle.

And yes, keep patting yourself on the back a d you may need PT for a rotator cuff injury. Of course you know more about PT than I do, you've got a friggin' doctorate. But why do you constantly have to tell us that? Isn't it intuitive that a PT knows more about therapy than anyone else?

You would think it'd be intuitive that PT's know best with regard to physical therapy, seems to me that it isn't.

What's with all the anger when a doctor lets you know HIS/HER goals for PT, or asks you to take it easy on a post op patient. The radiologist doesn't get all pissed off when I recommend a study and provide a pathology to be ruled out.

Maybe you should receive some referrals from some fellow docs with some of their podiatry goals on the referral, see how you like it. I think your opinion would change real quick.

Your issues are deep. Instead of pounding your chest and reminding them that YOU are the almighty DPT and they should leave it all up to you, you should graciously accept their referrals and realize that any goals of treatment or recommendations are NOT ill intended or meant to insult. You're just so damned insecure you can't accept that fact.

I graciously accept referrals all day long and am professional to other providers and with my interactions with patient's with respect to the referring provider, etc. There's a difference between my commentary on here and how I practice/what I say in the clinic (especially in front of the patient)

Apparently you have an authority issue and taking instructions or recommendations from anyone drives you looney.

I have issues taking instructions/recommendations from other people who think they are an authority with regard to PT, when they're not.

I've got you pegged. You were that kid that got beat up all the time when you were little. Now you are bitter.

Real professional. Are you a psychiatrist now? What'd your psychiatry goals for me be? Or would you just refer me to a psychiatrist and keep your mouth shut?

On a side note, I had a good friend who is a DPT and teaches at a very well known PT program read your comments. He was embarrassed to have you in the profession and assured me that your feelings are not the "norm".

Let him know that I've spent thousands of hours trying to make myself a better PT out of school, relentlessly try to help patient's I see, spent thousands of dollars on resources, am an APTA member and am sitting for the OCS this year. See if that tips the scale for him vs these posts I've been making. I wonder what's better? Me being a jackass on this thread and being a PT, or a conformist slacker PT who just goes with the flow?

The amazing part is you rant and rave but don't address the issues. Keep trashing podiatry, it will get you far in life. And just by your posts I can assure you that you're not in my league academically. You've got a lot of catching up to do........

I bet

Now why don't you take your medication, seek some anger management counseling and take the advice of your colleagues to be more diplomatic.

Thanks for teaching me the way to be a professional like you.

And I'd love to hear from other PTs if you get as crazed when any doctor writes an RX with goals or recommendations. After all, it doesn't indicate the doctor thinks he knows more than you, it's just a recommendation.

Recommendations from people out of a profession does not make sense. Intraprofessional recommendations do make sense (i.e. another podiatric surgeon referring to you, or a foot/ankle orthopod, etc). Do you think it'd be appropriate for a PT to recommend a surgery to you? Or would you scoff at that? I don't think you'd appreciate it at all. Keep in mind that's exactly what I see all day long.

Radiologists/Pathologists are physician's who do not treat or intervene as far as I know so this comparison to PT's is irrelevant.

 

[Fiveoboy11]

I noticed that you put clinic manager in quotations. Do you feel that clinic managers are impeding on the profession of a physical therapist? Perhaps their title should be changed to something else, such as "clinic coordinator" or "clinic advisor". Do you think "managers" bark out too many "orders" in general?

Thanks again for your valuable input as I learn more about the physical therapy profession.

Do you think clinical coordinators should ever "order" a DPM to do anything? I don't. The reference I gave before about the "manager", she was not a PTA or PT, or a clinician of any kind and she disputed my discharge of a patient, threw me under the bus. I was a prn PT at that clinic, on my second day I think. The PTA had been seeing this patient for over 60 visits. I decided to D/C because no progress was being made, the patient was s/p 3 MVA's in a short period of time (don't know how that happened). So, after I told the patient this was his last day, he went up front and the "manager" proceeded to schedule more appointments and had a "meeting" with the PTA that I could clearly see. Later on in the day the manager came back to where I was and very unprofessionally began to emotionally dispute my decision, i.e. "HE'S AN MVA!!" style. How would you like to be treated like that? Maybe you should experience that as a DPM and see how you like it.

 

[PADPM]

"Radiologists/Pathologists are physician's who do not treat or intervene as far as I know so this comparison to PT's is irrelevant".

Hmmmm. I believe there is an entire specialty called interventional radiologists, and they certainly do treat patients.

Actually I am very secure in my ability and welcome the input from ANY professional, if the ultimate outcome is the benefit of my patient. I am involved with training residents at major institution, and it's a very well respected program. Although I'm in practice for many years and have probably forgotten more than they even know, I always welcome their opinions and thoughts, even though I may not agree.

I have had pharmacists, nurses, PTs, etc., all discuss concerns or recommendations to me. I never get offended and attempt to understand and address those concerns. I believe that despite my expertise, I can always learn from others. The day that changes is the day I retire.

Unlike you I don't "take issue" with others that probably know less than me and are making recommendations. I know their intentions are not malicious, so it's my job to educate THEM and let them know if their recommendations are not indicated, but I will let them know the recommendations are always appreciated.

That's a concept you may want to consider. They know you're the expert, that's why they are referring to you. Understand their "recommendations" are not ill intended, though they may be ill advised. Instead of resenting these comments, it's a great opportunity to educate these people.

Not to mention that you get more bees with honey than you do with vinegar.

Please think about what I've said. It's a different perspective than yours, but may allow you to enjoy your day more.

 

[Ferocity]

"Radiologists/Pathologists are physician's who do not treat or intervene as far as I know so this comparison to PT's is irrelevant".

Hmmmm. I believe there is an entire specialty called interventional radiologists, and they certainly do treat patients.

Actually I am very secure in my ability and welcome the input from ANY professional, if the ultimate outcome is the benefit of my patient. I am involved with training residents at major institution, and it's a very well respected program. Although I'm in practice for many years and have probably forgotten more than they even know, I always welcome their opinions and thoughts, even though I may not agree.

I have had pharmacists, nurses, PTs, etc., all discuss concerns or recommendations to me. I never get offended and attempt to understand and address those concerns. I believe that despite my expertise, I can always learn from others. The day that changes is the day I retire.

Unlike you I don't "take issue" with others that probably know less than me and are making recommendations. I know their intentions are not malicious, so it's my job to educate THEM and let them know if their recommendations are not indicated, but I will let them know the recommendations are always appreciated.

That's a concept you may want to consider. They know you're the expert, that's why they are referring to you. Understand their "recommendations" are not ill intended, though they may be ill advised. Instead of resenting these comments, it's a great opportunity to educate these people.

Not to mention that you get more bees with honey than you do with vinegar.

Please think about what I've said. It's a different perspective than yours, but may allow you to enjoy your day more.

[Middle English, an expert, authority, from Old French docteur, from Latin doctor, teacher, from docre, to teach; see dek- in Indo-European roots.]

 

[Fiveoboy11]

"Radiologists/Pathologists are physician's who do not treat or intervene as far as I know so this comparison to PT's is irrelevant".

Hmmmm. I believe there is an entire specialty called interventional radiologists, and they certainly do treat patients.

Actually I am very secure in my ability and welcome the input from ANY professional, if the ultimate outcome is the benefit of my patient. I am involved with training residents at major institution, and it's a very well respected program. Although I'm in practice for many years and have probably forgotten more than they even know, I always welcome their opinions and thoughts, even though I may not agree.

I have had pharmacists, nurses, PTs, etc., all discuss concerns or recommendations to me. I never get offended and attempt to understand and address those concerns. I believe that despite my expertise, I can always learn from others. The day that changes is the day I retire.

Unlike you I don't "take issue" with others that probably know less than me and are making recommendations. I know their intentions are not malicious, so it's my job to educate THEM and let them know if their recommendations are not indicated, but I will let them know the recommendations are always appreciated.

That's a concept you may want to consider. They know you're the expert, that's why they are referring to you. Understand their "recommendations" are not ill intended, though they may be ill advised. Instead of resenting these comments, it's a great opportunity to educate these people.

Not to mention that you get more bees with honey than you do with vinegar.

Please think about what I've said. It's a different perspective than yours, but may allow you to enjoy your day more.

Fair enough, and if this is true and everyone behaved like this then the world would be a better place. Too bad many referring providers to PT do not understand that they are not the ultimate decision makers, if it were the opposite I would be on board with what you're saying 100% because I certainly do recognize the potential benefits from interprofessional respect and teamwork. By the way, are you saying your recommendations are optional? Or do you think it is a requirement of the PT to follow what your scripts say? Didn't you say the PT must call you for recommendations regarding the POC even though it's the PT POC? So, the PT must run by recommendations to you to do their job? That is backwards, isn't it? How about this, the PT sets the POC and you can make all the recommendations all you want, but it is up to the PT? Would you agree to that? Or is PT one of the exceptions for some odd reason?

Interventional radiologists are not the same as the radiologists that read your x-rays and report the results to you. Hence the not coincidental "interventional" radiologist.

 

[PADPM]

I do not dictate how the PT I refer to creates a treatment plan. I do write MY goals so the PT understands the reason for my referral. Similarly, when I refer to another medical specialist, I write what my concerns are with that patient. It doesn't dictate the doctor's treatment, it simply lets the doctor know why I am referring.

Yes, I appreciate if I actually request something specific for PT, based on my over 25 years of,practice, and a PT contacts me to let me know why he or she disagrees. Sometimes I may not want a post op patient to have something in particular since I know the intricacies of the surgery I performed and I can't expect the PT to know since he or she wasn't present during surgery.

For instance, let's say I performed a procedure involving a tendon transfer, and I know that the tendon wasn't in the best condition compared to similar procedures. I may ask for less aggressive care, since I'm the one that visualized the problem intra op and it isn't the norm.

The bottom line is that I consider us a team, and will communicate with the PT and vice versa for the optimal care of the patient. I don't let my ego get in the way of patient care.

I always do what I believe is best for my patient, without exception. If my recommendation offends you or the PT, I can assure you that was not my intention.

 

[Fiveoboy11]

I do not dictate how the PT I refer to creates a treatment plan. I do write MY goals so the PT understands the reason for my referral. Similarly, when I refer to another medical specialist, I write what my concerns are with that patient. It doesn't dictate the doctor's treatment, it simply lets the doctor know why I am referring.

Yes, I appreciate if I actually request something specific for PT, based on my over 25 years of,practice, and a PT contacts me to let me know why he or she disagrees. Sometimes I may not want a post op patient to have something in particular since I know the intricacies of the surgery I performed and I can't expect the PT to know since he or she wasn't present during surgery.

For instance, let's say I performed a procedure involving a tendon transfer, and I know that the tendon wasn't in the best condition compared to similar procedures. I may ask for less aggressive care, since I'm the one that visualized the problem intra op and it isn't the norm.

The bottom line is that I consider us a team, and will communicate with the PT and vice versa for the optimal care of the patient. I don't let my ego get in the way of patient care.

I always do what I believe is best for my patient, without exception. If my recommendation offends you or the PT, I can assure you that was not my intention.

What you're saying here is fine. BUT, there's a big problem with how things really work. You see, PT's receive referrals all the time, non surgical/surgical. Why is it that the surgeon or referring provider hardly ever includes information regarding their thought processes (i.e. what you were just talking about), that'd make it a lot better for the patient, and the PT! Example: you send a referral for PT s/p a tendon repair that is not as healthy as typical and therefore recommend slower progression/holding off on certain interventions. Do you write reasoning as to why that is accompanying your referral? Are we supposed to call and ask for reasoning on every single patient with anything written on the referral besides eval and rx? Why isn't there regulations that require referring providers to send the op report/imaging reports, etc with all referrals to PT? Don't you think you/your collegues should always communicate what you're thinking/your rationale vs "no strengthening" or "PROM only"? I can't even put into words how annoying and irritating that is sometimes. But, at the same time, I'm well aware that a fresh RCR should only be doing PROM, I don't need to waste my time reading that.

 

[MaxillofacialMN]

Five0, if I offered you a million dollars a year, would you work for a pod?

 

[PADPM]

There is an irony here. FiveO's greatest concern is that each specialty should stick to it's own turf, and he is obviously upset that MDs, DPM's, DO's may offer physical therapy services, even when provided by a licensed PT.

Yet this morning I received a newsletter from a local hospital highlighting the PT department. In the article it stated there is no need to go to a specialist for "over-priced" orthoses, since the PT's are now providing custom foot orthoses at their center at a discounted price.

Is there a contradiction here? I didn't know that PT's were experts in lower extremity biomechanics, orthoses, etc., anymore than I'm an expert in PT.

So, you can see that you can't point your finger at the DPM's and blame them for the world's trouble. There's plenty of blame to go around.