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Forecasting the Future
Being chosen as a McMillan Lecturer is considered APTA's highest honor, recognizing somebody who has made a distinctive contribution to the profession. Named after Mary McMillan, a pioneer in the field of physical therapy, the lecture celebrated its 40th anniversary at PT 2009.
This year's honoree was Carolee J. Winstein, PT, PhD, FAPTA, who has enjoyed a distinguished 36-year physical therapy career. She is currently professor and director of research in the Division of Biokinesiology and Physical Therapy at the University of Southern California (USC). Dr. Winstein is also director of the Motor Behavior and Rehabilitation Laboratory at USC.
Her lecture, titled "The Best We Can Be is Yet to Come," focused both on the past of physical therapy and more importantly its future. "Thank you for giving me this tremendous honor," she said to open the session. "Preparing for this lecture over the past year has been one of the most daunting tasks I have ever undertaken. There were times that I almost gave up. But it has also been one of the most exhilarating experiences of my life."
All PT professionals share one thing in common that brought them into physical therapy and likely keeps them going, she continued.
"That is the patients we touch and care for. In 2009, how can the physical therapy profession reach its full potential? I believe we must emphasize self-confidence over arrogance and be secure enough in ourselves to seek guidance and advice from outside the profession. I also think that PT educators, practitioners and researchers should be equally valued."
Physical therapy needs to enforce the highest standards, Dr. Winstein continued.
"We must resist the temptation to compromise. This is one of the most challenging times ever faced by our profession and the healthcare system in which we practice."
To achieve its goals, physical therapy must first shore up its academic foundations, the speaker continued. "I have had the privilege of spending the majority of my career in academic settings. We could argue that my academic experience outweighs my clinical experience. And certainly many things have changed in clinical practice since I left it on a full-time basis in 1982. But I've learned over many years of experience in academics and clinical practice that good things take time. And nothing good comes easily without effort."
Dr. Winstein advocates a foundation of mutual respect within the profession, honoring what each colleague brings to the table.
"I think there is no place for divisiveness, unhealthy competition or devaluing," she said. "We are equal partners in our quest for excellence. Our specialties and skills may differ but we are far stronger when we embrace our differences. The old notion of an academic center being an ivory tower isolated from clinical practice is shattered by a partnership model."
It is a good sign that NIH funding for rehabilitation has begun to increase, noted Dr. Winstein.
"Only recently has physical therapy been viewed on a par with other health care professions like pharmacy, dentistry and nursing. I am convinced the most important aspect for the survival of physical therapy and its external reputation is the quality of our academic programs."
The profession has definitely come a long way since the 1st McMillan Lecture in 1964, she added.
"But much of our effort has been focused on self identity and progression. It is now time to ask how we are viewed from the outside and not be limited by our inner vision. Beyond a doubt, the top concern today is our miserably fractured healthcare system. Something that should be embarrassing to a country that used to set the standard in world healthcare."
The challenge is to implement a system that will improve performance and reduce costs, she commented.
"We must be smart, seize opportunities and meet challenges to survive the changes that will take place, including increased use of telehealth and advanced technology. In the end, we are all in this for the good of the patient. Childish battles among ourselves only hinder our ability to advance. We are all passionate about our profession and its future."
APTA also announced that Andrew Guccione, PT, DPT, PhD, FAPTA, was chosen to deliver the McMillan Lecture at PT 2010 in Boston next June.
--Brian W. Ferrie
Regulations: A 'Necessary Evil'?
Do we really need all of the regulations Medicare and the physician fee schedule places on the PT profession-or do the regulations just make practicing PT more cumbersome and confusing?
Likely a little bit of both, according to the panelists at the 2009 Rothstein Debate, "When Does Regulation Become Over-Regulation, and When Does Under-Regulation Invite Abuse?"
The debate was held June 12, with panelists Larry Benz, PT, DPT, MBA, ECS, OCS, and Stephen Levine, PT, DPT, MSHA.
"Medicare is very complex; what we want to discuss is the concept of regulations and how they apply to us as practitioners," said Anthony J. DeLitto, PT, PhD, FAPTA, moderator for the debate.
Taking the "over-regulation" side of the debate, Dr. Benz said rules and regs are needed, but they tend to creep, and thus the profession ends up with rules on top of more rules. "This tends to demoralize; go into any clinic and you can tell which therapists are treating Medicare patients versus those who aren't. The rules are well-intended but the consequences are rarely discussed. We acquiesce to a certain number that puts a cap on our earnings. Regulation causes many therapists to act immorally," Dr. Benz said.
But Dr. Levine, taking the supporting position on regulations, responded that in essence, regs get a bad reputation that does not always apply. "There are many misconceptions about regulations and why they exist. They provide for some standardization of rules. They are very complex and don't always make sense but the result of not having them can be severe." The profession needs standardization, he said, much like speed limits on roads. "Most PTs operate in a few settings where the rules are transparent. Health care fraud and waste costs millions of dollars every year, so regulations are necessary."
The panelists addressed questions on the cost of deregulation to the PT profession, and whether the APTA and state governing bodies also do enough to influence how regulations are written and applied-and if they should be involved at all.
"The problem is there are too many regulations," Dr. Benz opined. "The pendulum should begin to swing the other way. Only nuclear power control seems to have more than our profession." Dr. Benz said another problem is that bureaucrats to make the rules are "far removed from the therapists and their patients. Autonomy in PT should unshackle practitioners from added rules."
But Dr. Levine said an overabundance of too ambitious regulations "is a myth, a misperception. We can't have things both ways. What we are paid to do is based on one-to-one care of therapist to patient. We can't be paid as if we are doing the service and also are able to use care extenders for example." Through physician-fee regulations and coding on one-to-one care and incident-to examples, others end up determining how PTs get paid, he admitted. "It's like auto insurance. But we can still define how we want to practice; APTA has a position that only PTs and PTAs can provide services."
But regulations end up limiting the profession, Dr. Benz countered. "Physicians don't limit themselves (in payment) in this respect, but PT does," thanks in essence to over-regulation.
Both panelists agreed that the profession needs to better police itself in order to mitigate some rules and that most clinicians try to do the right thing regardless of how they are governed by regs. They also concurred that in some ways, the cost to the profession of not having at least some payment/fraud regulations would be much higher than the costs of implementing regulations and teaching therapists to follow them.
The "Current Controversies: Rothstein Debate" was established annually in memory of Jules Rothstein, PT, PhD, FAPTA, Editor-in-Chief Emeritus of the Journal of Physical Therapy.
--Lisa Lombardo
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