PT vs. Chiropractic

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mtm34

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Hi I'm heading into my senior year as a rehabilitation science major and am planning on applying to both chiropractic and physical therapy schools this summer. I was looking for insight on the comparison between the two professions from an educational and clinical perspective. I am more interested in PT but I feel like earning a DC will be a more lucrative position with a higher roof in regards to setting up personal/private business and what not. Any insight is much appreciated
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I would definitely be talking to folks currently in the Chiropractic field before going that route. I don't think you will end up deciding to pursue it. There is a ton of information about the chiropractic field out there on the internet that can be helpful. Do a google search. Don't pay attention to the chiro school administrators. They don't care about you. They just want your money. They'll tell you what you want to hear. Chiropractors have one of the highest school loan default rates among professionals. The median income stated in the BLS is overstated for most Chiropractors (do a search you'll find what I'm saying.) I don't think that this profession will sustain twenty years from now with utilizing their current methodolgies. The medical community for the most doesn't recognize them as part of the picture. People will be going to Doctors of PT 20 years from now for musculoskeletal conditions. Chiropractors need to re-identify with what there roll is. I see them becoming more like "health experts" that are generally dealing with healthy people that are looking for "optimal health." Just my opinion. Good luck with your search.
 
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"The biggest competitive threat will come from physical therapists."

- The Future of Chiropractic Revisited: 2005-2015, written by a panel of chiropractors
 
They both have a different philosophy of treatment.

I believe chiropractic has the highest loan (HEAL) default rate amongst licensed healthcare professonials by far if I remember correctly. I used to have a link to confirm that datum, I think you can find it somewhere in the bureau of health professions under the health resources and services administration website. In any event, such a significant default rate is something to be cautious of.
 
It is interesting that this should come up...a friend of mine sent me this in an email today...the video is approximately 40 minutes long. Judge for yourself while you watch it.


If anything, this is well worth the watch.


http://ph-ms.ouhsc.edu/ah/rehab/kinsinger.wmv




Sorry didn't realize that file was already up.
 
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I spent a lot of time researching both Chiro and PT. I have also seen the Kinsinger video that is referenced. I am definitely now convinced that the Chiro field is just full of some real shady practices and is not an evidence based science. Just spend a few hours on-line examining the arguments, reading a few forums and looking at the evidence about Chiro and I think you will be like me and run from any thought of going to a Chiro school! Somewhere I saw that they have the highest rates of student loan default by a long shot. Also consider that no Chiro school has been established by any University in the country. They are all private (and I believe mostly for-profit) stand alone institutions. Hmmm... That says something as well!
 
Before applying to PT schools, I was also considering Chiropractic not knowing what their philosophy was all about. Thank god, I did my research before moving onto this field.

I remember one of the Chiro school reps coming to my school to convince us ES majors to pursue a career in chiro. they told us that our school had 100% acceptance rate into their school. 100%? I looked at their prereqs. I saw that they had org chem I and II listed as a requirement. The rep told me that they could waive that requirement for me. And min GPA to get in? 2.5 it was. Yes, all you need is a 2.5 to get into a chiro school to become a so-called chiro physicican. 4 years of schooling for what? Yeah they treat everybody right? If a chiro is so much into subluxation and truly believes in it, would he/she treat someone with a UTI and someone with a backpain any other way than cracking his/her back? i don't think so. So the treatment plan is this. It's pre-determined. they come to see the chiro. Chiro takes x-rays. chiro informs the patient that her vertebral column is not aligned, therefore needs to be adjusted. That is the cause of all health problems.

So my question is this. Do you really want to be a part of a belief system (nothing to do with medicine) such as chiropractic? I just can't picture myself fooling my patients into such scam. I don't even know how they are still allowed to practice.
 
DPTWannabe said:
I spent a lot of time researching both Chiro and PT. I have also seen the Kinsinger video that is referenced. I am definitely now convinced that the Chiro field is just full of some real shady practices and is not an evidence based science. Just spend a few hours on-line examining the arguments, reading a few forums and looking at the evidence about Chiro and I think you will be like me and run from any thought of going to a Chiro school! Somewhere I saw that they have the highest rates of student loan default by a long shot. Also consider that no Chiro school has been established by any University in the country. They are all private (and I believe mostly for-profit) stand alone institutions. Hmmm... That says something as well!
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univ of bridgeport ct
 
I read an old thread on chiropractic earlier today where some "attending" was trying to argue that chiropractors are science-based. Really? That's just plain embarrassing. The whole theory of Chiropractic is based on vitalism and the crazed relgiosity of a grocery store owner and magnetic healer named D.D. Palmer. Need I go on...

If you want to do something like Chiropractic that at least attempts to attain some measure of scientific validity become a DO and do OMT...or you could go to PT school & in some states they will allow you to practice OMT as a PT. either way you'll know more and likely make better money than you will being some chiropractor's underling doing postural screenings at Whole Foods.
 
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people need to come on here and completely slander the whole chiropractic profession. I'm attending PT school in the fall and I dont feel the need to completely question the legitimacy of the field to validate that PT is better. A few years ago I was in a terrible accident and suffered injuries to the head, consequently having postural damage. I dont know what state I would be in today without the work of my chiropractor (physical therapists as well)...so although its not as scientifically based, it addresses spinal issues not addressed by other professions. Theyre obviously doing something right.
 
Trueblue12 said:
people need to come on here and completely slander the whole chiropractic profession. I'm attending PT school in the fall and I dont feel the need to completely question the legitimacy of the field to validate that PT is better. A few years ago I was in a terrible accident and suffered injuries to the head, consequently having postural damage. I dont know what state I would be in today without the work of my chiropractor (physical therapists as well)...so although its not as scientifically based, it addresses spinal issues not addressed by other professions. Theyre obviously doing something right.
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I'm not sure what you mean by this response, but it does prove you don't know about OMT because that was the basis for my argument not to bother with Chiropractic School.

Osteopathic Physicians trained in OMM do everything a chiropractor does plus a whole lot a chiropractor doesn't. Plus he or she is still trained as a physician, had to go through at least 3 years of clinical residency dealing with patients who are acutally ill. Plus they can write prescriptions.

but hey don't take my word for it check out www.chirobase.org and then wiki OMT....
 
DRJJ1 said:
univ of bridgeport ct
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Including their accreditation from the Commission on Accreditation of the Council on Chiropractic Education doctoral (D.C.) degree program in chiropractic, they also have robust affiliations with these accrediting bodies:


  • The Master of Science in Acupuncture program is accredited by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM), which is the recognized accrediting agency for the approval of programs preparing acupuncture and oriental medicine practitioners.


  • The College of Naturopathic Medicine is accredited by the Council on Naturopathic Medical Education (CNME), which is recognized by the U.S. Department of Education.


http://www.bridgeport.edu/pages/3229.asp
 
PTapp said:
Yeah they treat everybody right? If a chiro is so much into subluxation and truly believes in it, would he/she treat someone with a UTI and someone with a backpain any other way than cracking his/her back? i don't think so. So the treatment plan is this. It's pre-determined. they come to see the chiro. Chiro takes x-rays. chiro informs the patient that her vertebral column is not aligned, therefore needs to be adjusted. That is the cause of all health problems.

So my question is this. Do you really want to be a part of a belief system (nothing to do with medicine) such as chiropractic? I just can't picture myself fooling my patients into such scam. I don't even know how they are still allowed to practice.
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Yes a DC is going to adjust your back, neck, limbs...that is what he/she is trained to do. No treatment plan is pre-determined, you don't adjust the same segment on every patient. Sometimes you dont adjust at all. I'd almost say that the medical approach is pre-determined:
Hi I'm the doc and here's your script. What do MDs do that's so different from patient to patient; you do what you are trained to.

Dr. Chung Ha Suh of the University of Colorado showed that even a small pressure (about the weight of a dime) on a nerve can reduce the function of the nerve by 60 percent and that the nerve will start to degenerate if the pressure is sustained for three hours. How do you not believe in this. We adjust therefore reducing this compression. And now you're probably going to say well a DO can do that. Maybe, but they are not specific in their adjustments. They spend very little time in school on such subjects. On the other hand DCs spend years refining their technique. If they need to adjust one specific vertebra, they will adjust that one.

I've never heard of a DC curing a UTI from an adjustment. They might still adjust that patient but in no way would they tell the patient that they are healed after being adjusted. They may try homeopathic meds but I'm sure you dont believe in those either.

You might be right in saying that we have nothing to do with medicine, afterall we don't wright scripts. Also we actually spend time with our patients and look at them as a whole, not as symptoms. Which brings me to another difference. MDs treat symptoms not the problem.

Lastly, I'm not here to fight medicine. I believe in it. But there is something to be said for chiropractic and the numerous problems it can help/prevent. If you are interested in some research, let me know.
 
Lastmanstanding said:
I read an old thread on chiropractic earlier today where some "attending" was trying to argue that chiropractors are science-based. Really? That's just plain embarrassing. The whole theory of Chiropractic is based on vitalism and the crazed relgiosity of a grocery store owner and magnetic healer named D.D. Palmer. Need I go on...

If you want to do something like Chiropractic that at least attempts to attain some measure of scientific validity become a DO and do OMT...or you could go to PT school & in some states they will allow you to practice OMT as a PT. either way you'll know more and likely make better money than you will being some chiropractor's underling doing postural screenings at Whole Foods.
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Well it's not always easy to get the money needed to do studies when you arent in the pocket of big pharma. But if you do the research you will see that chiropractic works. I'm not saying it's going to cure everyone and everything but medicine cannot make that promise either. I really don't understand why there's such an animosity between the 2 professions
 
spinalcavitator said:
On the other hand DCs spend years refining their technique. If they need to adjust one specific vertebra, they will adjust that one.
If you are interested in some research, let me know.
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I'd be interested to see the specificity of your techniques (peer-reviewed journals please) because I've always been told that you can't target a specific segment with any true accuracy.

also what are chiros thoughts on the cavitation or "pop"? Is it necessary for the treatment to be effective or is the motion which decompresses said nerve sufficient?
 
D.P.T. trumps Chiro. You might make a little more moolah as a Chiro, but your job satisfaction is gonna suck goat balls. Why? Because you will not in the slightest way be healing anyone. You will hate yourself for feeding out pseudo-diagnises of sciatica which could be better cured through physical therapy. Also Chiros aren't a welcome part of the larger health care team whereas D.PT.s, O.C.T.'s, or whichever designation of physical therapists are.

I'm pretty sure if Chiros we're no longer able to "practice" there would less incidence of disease as those dumb ass patients would eventually seek out effective health care. Booyah.
 
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I love how Physical Therapy people think they are GODS or something.. here they're bashing chiros (which I'm not a big fan of) and elsewhere they have absolutely no problem bashing athletic training.

If only healthcare providers would understand that we all have a job to do and we all are important in some way to the healthcare of this nation..
 
atstudent said:
I love how Physical Therapy people think they are GODS or something.. here they're bashing chiros (which I'm not a big fan of) and elsewhere they have absolutely no problem bashing athletic training.

If only healthcare providers would understand that we all have a job to do and we all are important in some way to the healthcare of this nation..
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I am an ATC, and formerly was blinded by my pride just as you seem to be. You are correct, athletic trainers and most health professionals have their place in healthcare. But an athletic trainer's "place" is not billing for PT. Athletics is the realm of the athletic trainer. Yes, we are preached to in our ATEP programs that we treat the physically active. This just isn't right. I have a 88 year old grandmother who walks an hour a day. She is physically active, but I know I am not prepared to provide therapy for her fibromalacia. The PTA with a two year degree has more knowledge and is better prepared to treat her than I am with my four year bachelor's.
My point is that the members of this forum are not bashing athletic trainers or the profession of athletic training. They are simply arguing against the AT profession's push to expand its scope without making the necessary changes in its curriculum to make that effort valid.
 
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CLGUY said:
I am an ATC, and formerly was blinded by my pride just as you seem to be. You are correct, athletic trainers and most health professionals have their place in healthcare. But an athletic trainer's "place" is not billing for PT. Athletics is the realm of the athletic trainer. Yes, we are preached to in our ATEP programs that we treat the physically active. This just isn't right. I have a 88 year old grandmother who walks an hour a day. She is physically active, but I know I am not prepared to provide therapy for her fibromalacia. The PTA with a two year degree has more knowledge and is better prepared to treat her than I am with my four year bachelor's.
My point is that the members of this forum are not bashing athletic trainers or the profession of athletic training. They are simply arguing against the AT profession's push to expand its scope without making the necessary changes in its curriculum to make that effort valid.
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Right. The PTA is not qualified to evaluate a grade one ankle sprain and the AT is. Its called scope of practice. The PTA is not qualified to evaluate anything technically. They are assistants. The athletic trainer is the evaluator and treator and basically the mommy to all of their athletes. They are the liason between the MDs and the players and the coaches.

I don't get why some, like atstudent, apparently have such a low opinion of the athletic training profession. ATs do athletic training much better than PTs do, in fact, PTs aren't qualified to do ANY on the field assessments/emergency management/off season prep work unless they have had special training and even then, I don't think anything replaces the 800 or 1500 or whatever number of clinical hours are required now to sit for the national NATABOC exam.

PTs defending their practice is NOT bashing athletic training. What do the trainers say when a local PT or chiro is calling themselves the "trainer". I know I bark about it. Its my profession and if they are not a certified athletic trainer, they can't call themselves one. Just like when an athletic trainer says they are doing physical therapy, I bark at that one too, because AT ain't PT.

You choose to go to school to do a certain thing or work with a certain population and then, when you are in school, you decide that you want to work with grandma??? The go to PT school. Athletic trainers work WITH ATHLETES.

End of rant.
 
So why shouldn't athletic trainers be able to bill for treating athletic injuries in a sports medicine clinic?

I personally do not feel that athletic trainers should be treating anybody and everybody. My thought is though that athletic trainers are more than capable of dealing with many orthopedic injuries to get somebody back into running, exercising, or going as far as getting back into their athletic event. It seems physical therapists (at least in the larger scale) do not feel that athletic trainers are capable of doing so. They cite a lack of education "because athletic trainers only have a bachelors degree."

Athletic Trainers and Physical Therapists have different goals just by nature of the job. You know this. An athletic trainer is trying to return an athlete to play. A physical therapist returns a patient to activities of daily living.

CLGUY, most of my complaint is not from this forum. It's from other places on the web and just overall. I work in a physical therapy clinic as an aide while I'm still in school. Physical Therapists and Athletic trainers have somewhat similar jobs, but there are many differences too.
 
atstudent said:
So why shouldn't athletic trainers be able to bill for treating athletic injuries in a sports medicine clinic?

I personally do not feel that athletic trainers should be treating anybody and everybody. My thought is though that athletic trainers are more than capable of dealing with many orthopedic injuries to get somebody back into running, exercising, or going as far as getting back into their athletic event. It seems physical therapists (at least in the larger scale) do not feel that athletic trainers are capable of doing so. They cite a lack of education "because athletic trainers only have a bachelors degree."

Athletic Trainers and Physical Therapists have different goals just by nature of the job. You know this. An athletic trainer is trying to return an athlete to play. A physical therapist returns a patient to activities of daily living.

CLGUY, most of my complaint is not from this forum. It's from other places on the web and just overall. I work in a physical therapy clinic as an aide while I'm still in school. Physical Therapists and Athletic trainers have somewhat similar jobs, but there are many differences too.
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First, I have both credentials so I either have no dog in the fight, or two dogs however you want to look at it.

I think the "they only have a bachelors degree" arguement is bogus and the people that employ that as why AT is less qualified are idiots. The professional program for PT even with a Doctorate is 3 years at most. two of the years for athletic training are usually almost 100% clinical. Most of the last year in PT school is rotations anyway. AT does that WHILE they are taking classes. That said, when the athetic trainers work with people in sports medicine clinics, they are prescreened for medical problems by the doc and the PT. They can bill for athletic training services but will not probably be paid because its not recognized by many insurers. One of the reasons for that is that AT has not demonstrated competency in non-athletic patients OR patients that are not within the structure that is team-like. ATs have worked in industry for years basically being the "company" trainer. They don't bill for their services, they practice within their scope, have a "team doctor" and get paid a salary, just like a real team trainer does.

When AT starts having classes in geriatrics, liver metabolism, rheumatology etc . . . they might get some recognition and ability to treat outside the athletic world and bill for it.
 
atstudent said:
I love how Physical Therapy people think they are GODS or something.. here they're bashing chiros (which I'm not a big fan of) and elsewhere they have absolutely no problem bashing athletic training.

If only healthcare providers would understand that we all have a job to do and we all are important in some way to the healthcare of this nation..
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I know, we have a pretty bad reputation, and now is even worst with the DPT. Even though I do not agree (beacause I don't think I'm god) in a way a I DO agree because I've seen that attitude among few classmates, and I'm not even in the program yet =S, and also I've noticed a little of friction among OTs an Pts too :laugh:

However, I also agree with CLGUY we all have our place in health care, but it needs to be defined and prevent orselves from doing things out of our scope of practice
 
I'm not sure how this evolved so quickly into a debate about the role of the ATC in physical therapy, but since it already has, I figure I will weigh in with my two cents.

I've worked as an aide in an outpatient ortho clinic for almost two years, and I will be a first year DPT student in August. I support athletic trainers in such an environment because up to now, I feel that I've seen ATC's used effectively, safely, and within (what I understand to be) their scope of practice. My clinic divides their staff into teams. There is a PT, a trainer, and a PTA. Patients may be scheduled with any of the three (for RV obviously) and the ATC is used occasionally for patients with simple overuse injuries, sports related injuries, and the like. Medicare patients and patients with complex non-orthopedic chronic conditions are seen by the PT/PTA ONLY.
Now, that's all fine you might think, but what happens if the patient starts to show signs of an ailment outside of the ATC's scope of practice? Well, for example, one patient had been seeing the ATC on the "blue team" in our clinic for anterior knee pain. One day, she presented with classic symptoms of L5/S1 neuropathy after a weekend of gardening, and she stopped her HEP due to the pain. The team PT made a clinical diagnosis and and care given by the ATC was ceased. The patient was referred back to her physician and a secondary diagnosis was made.
So my question becomes, with proper diagnostic procedures by a physician followed by a clinical diagnosis by a PT, supplemented with oversight by the PT on site, why is it so necessary for an ATC to have "classes in geriatrics, liver metabolism, rheumatology etc"? They neither treat patients with those conditions nor do they claim the ability to.
We are able to use ATCs in clinics safely and effectively. It helps with cost containment, scheduling flexibility, and allows our staff to have a broader base of expertise.
So what other reason is there for PTs to want ATCs out? Is it a turf war? I would like to think we are acting in the best interest of our patients, and not out of financial gain.
I do somewhat question the motives of those who say the ATC has zero place in an orthopedic clinic, because I have seen it done very safely for so long (and in multiple settings). One of the roles of an athletic trainer is intervention of acute and chronic medical conditions involving impairment, functional limitations, and disabilities. Does that not describe how they are used in the case I described?
Again, I'm just trying to have an open debate, I hope that doesn't offend anyone!
 
I am wondering how this turned into a PT vs. ATC debate. We are quite off topic now.
 
MinnDasota said:
I am wondering how this turned into a PT vs. ATC debate. We are quite off topic now.
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In other words, let's go back to making ourselves feel better by bashing chiropractors, right?
 
facetguy said:
In other words, let's go back to making ourselves feel better by bashing chiropractors, right?
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....I just like hearing what people have to say (hence the topic of this post). I have never bashed chiros on this or any forum. As long as there are PTs and chiros in this world, there will always be this debate.

I think it is unfair for you to assume that I need to bash chiro to feel good about myself or my profession. Some of us do have open minds!
 
MinnDasota said:
....I just like hearing what people have to say (hence the topic of this post). I have never bashed chiros on this or any forum. As long as there are PTs and chiros in this world, there will always be this debate.

I think it is unfair for you to assume that I need to bash chiro to feel good about myself or my profession. Some of us do have open minds!
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Don't take it personally. I was referring to the thread itself and others like it which invariably devolve into chiro-bashing rather than debating anything. And what's there to debate? Both professions have a place in healthcare.
 
facetguy said:
Don't take it personally. I was referring to the thread itself and others like it which invariably devolve into chiro-bashing rather than debating anything. And what's there to debate? Both professions have a place in healthcare.
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I just think we need to refocus this thread to help the OP in deciding which direction is better suited for him/her. Thus, there is a debate to be had so the OP can make an educated/informed decision.

So to help the OP out:

As a PT, you will have a moderately comfy living depending on the amount of loans you take out (which is why private vs public school is so widely debated on here). The salary doesn't seem to range as widely as chiro as some chiros make a ton while some don't seem to make enough. PTs will usually make somewhere between 50K-85K dependent on experience and place of work (>100K if you own a practice). Educationally, PT is rooted in evidenced-based practice and many PT schools are tied to medical schools which is a huge plus. PT education is also very generalized (it gets more specific dependent on each schools curriculum and the clinical rotations that you choose). Based solely on requirements, it seems that PT school reqs are more rigorous than chiro which can make it tougher to get in. I will let a chiro speak for their education as I don't know enough to comment on it.

Overall, PTs are working to be more autonomous (via direct access) but will always work closely with the MD/DOs as a part of the larger health care team. Chiros have autonomy and are much more independent than PT (which is the main reason why they have the ability to make more money). With that, the downside is the increase of malpractice (the more independent/autonomous a profession is, the higher the chance). However, like any good practicioner, if you stay within your scope of practice and make sound judgements you should be able to practice and avoid this throughout your career.

The biggest positive for PT is job satisfaction. It is always ranked as one of the top jobs for job satisfaction.

Most PTs don't go into the profession to own a practice, but the opportunity is there, just like in chiropractic. Owning a practice in either profession takes a lot of time, money, and business knowledge. (There are PT programs that have the DPT/MBA which seems to be perfect for those who know they are going to open a practice someday). Either way, if you can get patients to walk through your doors (PT or chiro) and have them leave happy, you will make a lot of money.

I hope that helps you out a little bit. Sorry it was more about PT than chiro.
 
Coach Hoski said:
So my question becomes, with proper diagnostic procedures by a physician followed by a clinical diagnosis by a PT, supplemented with oversight by the PT on site, why is it so necessary for an ATC to have "classes in geriatrics, liver metabolism, rheumatology etc"? They neither treat patients with those conditions nor do they claim the ability to.
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But coach, the point is, that they do claim to do so at times, and many (some?) are capable but in general, when the patient goes to the PT clinic, they are entitled to see a PT, with all of the responsibilities and expectations associated with that title/training. Hell, people introduced me to their friends at graduation parties this weekend as a physical trainer so I know that the fields overlap but I know for certain, that many (most) of my classmates in athletic training were NOT capable of even recognizing that something was outside of their scope. Don't get me wrong, I have the highest respect for athletic trainers in their area of expertise but in general, a good athletic trainer is no match for a good PT in the clinic. The reverse is true on the field.

The position the NATA seems to be taking, correct me if I am wrong, is that the ATC is capable of functioning as a physician extender. Essentially allowing an orthopedic group to do all of their rehab in-house. Making it a self referral since the rehab revenue comes back to them. There is a serious conflict of interest here. Anyone ever look at a protocol from an orthopod and say, OK, I am going to follow this to the letter? NO, we are professionals and the protocol is a framework. My contention is that the self referral (orthopedist to athletic trainer that is employed by said orthopedist) is unethical just as POPTs are unethical, just as physician owned imaging centers is unethical etc . . .

The claim is that in an orthopedic setting PT = ATC and I don't think that is accurate. The breadth of the PTs training is much more suited to the clinic and the ATCs breadth of training includes things that are not in the PT curriculum.

When you get a patient from an orthopedist or a Family Practice doc with LBP, to you really think that they looked first at their liver? or do you think that they expect the PT to screen for what is NOT musculoskeletal? The ATC may not be capable of that, the PT should be.

It may have worked in your clinic, and it worked in one that I worked at 12 years ago but observing even outstanding ATCs they did not measure up clinically with average PTs.
The screening process for acceptance for athletic training programs is much less stringent than that of PT. The filtering out of the weak happens on the job and that is not fair for the patient. If someone has ATC behind their name it suggests certain skills and abilities that can be assumed. Same with PT.
 
truthseeker said:
But coach, the point is, that they do claim to do so at times, and many (some?) are capable but in general, when the patient goes to the PT clinic, they are entitled to see a PT, with all of the responsibilities and expectations associated with that title/training. Hell, people introduced me to their friends at graduation parties this weekend as a physical trainer so I know that the fields overlap but I know for certain, that many (most) of my classmates in athletic training were NOT capable of even recognizing that something was outside of their scope. Don't get me wrong, I have the highest respect for athletic trainers in their area of expertise but in general, a good athletic trainer is no match for a good PT in the clinic. The reverse is true on the field.

The position the NATA seems to be taking, correct me if I am wrong, is that the ATC is capable of functioning as a physician extender. Essentially allowing an orthopedic group to do all of their rehab in-house. Making it a self referral since the rehab revenue comes back to them. There is a serious conflict of interest here. Anyone ever look at a protocol from an orthopod and say, OK, I am going to follow this to the letter? NO, we are professionals and the protocol is a framework. My contention is that the self referral (orthopedist to athletic trainer that is employed by said orthopedist) is unethical just as POPTs are unethical, just as physician owned imaging centers is unethical etc . . .

The claim is that in an orthopedic setting PT = ATC and I don't think that is accurate. The breadth of the PTs training is much more suited to the clinic and the ATCs breadth of training includes things that are not in the PT curriculum.

When you get a patient from an orthopedist or a Family Practice doc with LBP, to you really think that they looked first at their liver? or do you think that they expect the PT to screen for what is NOT musculoskeletal? The ATC may not be capable of that, the PT should be.

It may have worked in your clinic, and it worked in one that I worked at 12 years ago but observing even outstanding ATCs they did not measure up clinically with average PTs.
The screening process for acceptance for athletic training programs is much less stringent than that of PT. The filtering out of the weak happens on the job and that is not fair for the patient. If someone has ATC behind their name it suggests certain skills and abilities that can be assumed. Same with PT.
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Thanks for responding, I love the opportunity to hear from someone who has a lot of knowledge on this issue. It's something I've been interested in since working in two different settings that use ATCs in such a manner, and ever since I've been curious to know what the popular consensus is among physical rehabilitation clinicians.
First off, I completely agree with your first two scenarios. Patients with more complex or non-musculoskeletal disorders are clearly not well served to see an ATC for rehab. It is clearly outside of their realm to do so, and I would concur that any incidence thereof is dangerous. I guess that I am looking at it based on the current process where said LBP pt is initially screened by a PT and then during return visits may be seen by an ATC. I believe someone stated that every 4th/5th visit the patient is again seen by a PT. Is that fair to the patient? Maybe, I suppose you could say that people have a choice in where they undergo their rehab. Philosophically speaking, this could be a decision made by each clinic. I would say that in my experience this has been O.K. when used appropriately.
As for NATA, they do want to act as physician extenders as stated in the ATEAM legislation. I spoke this winter with the director of an M.S. AT program who said just as much. I do not support that bill as is, mainly because of the potential for what as you stated is a conflict of interest, and also would most likely push ATCs outside of their scope of practice. They are really pushing their boundaries and need to understand where their specialties lie.
So finally, I reiterate that after, and only after, proper diagnosis and screening from a primary care physician or physiatrist, and a clinical PT on site, it seems to me that it is safe and effective to allow ATCs to see certain patients for return visits per the philosophy of each rehab setting.
I guess that's where we might differ for now, though I hope to keep learning the pros and cons of this in PT school and in the field. :)
 
Coach,

My point of view is, Philosophically, good ATCs are very good clinicians, better than PTAs IN GENERAL. However, the reimbursement rules do not really recognize ATCs with regard to Medicare, Blue Cross, etc . . . Therefore their regulations would have to change before hiring an ATC directly in my clinic would be sensible. The practical problem for PTs is that even if we did support the acceptance of ATCs in the clinic, it would probably be like stabbing yourself in the back. You may have a certain type of ATC in mind when we look at the NATA proposed legislation and support it, but its the other kind of ATC that is going to take advantage of (and be taken advantage of) the law, work for the orthopedists and poof, the referrals dry up.

In my ideal world, physicians would not be able to employ ATCs as extenders (ie provide rehab in their offices) but insurance would allow ATCs to be PT extenders in orthopedic clinics. I would rather have the skill set in my sports medicine clinic of a typical ATC than those of a typical PTA. In a general type clinic, where I work now (75% OP ortho/sports, 25% nursing home, IP, incontinence and home health) I would have no or very little use for an ATC. More clinics are like mine than are like the one you worked in and the one I worked in before.
 
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