One of the most important cost saving concepts in medicine today is the use of the physician extender. When I started practice in 1985, there was no such term; but look up ‘physician extender’ in the dictionary today, and you’ll find: “a health care provider who is not a physician but who performs medical activities typically performed by a physician.”
Physician extenders can provide care at a lower cost to patients and their insurance companies. They are competent in treating many health care issues, and have the knowledge, training and experience to determine when a physician consult is appropriate. Usually, we think of Physicians Assistants or Certified Family Nurse Practitioners.
But there are other health care providers who are primary care providers for patients with musculoskeletal problems: Certified Athletic Trainers and Licensed Physical Therapists.
Athletic Trainers (ATC) certified by the National Athletic Trainers Association typically work in institutional settings. They are usually the first responders at an injury scene. They triage the injured athlete and decide if a physician consult is appropriate. For minor problems, the patient is managed without physician involvement.
Most Physical Therapists (DPT) are doctorate degreed professionals licensed through their respective state Boards. Their practice requirements are similar to Physician Assistants. In a recent study of family practice and orthopedic physicians, published in The Journal of Orthopedic Sports Physical Therapy, physical therapists were found to be second only to orthopedic surgeons in performing competent musculoskeletal exams.
Physical therapists have been physician extenders throughout the world for a long time, but only in the past 15 years has the American medical community endorsed the model. Recent research demonstrates it is safe and effective and 49 states (including Virginia) are considered Direct Access states; that is, referral by a physician is not necessary in order for care to be provided by a licensed physical therapist.
For my Direct Access Licensure, I obtained further education for differential diagnoses and additional course work. Since 2011, I have been practicing Direct Access Physical Therapy.
I must admit I was hesitant to endorse my profession as physician extenders. I was trained thirty years ago under a traditional model and continue to have great respect for our physician community and the medical profession. But times change, our education has progressed to doctoral level training, the research is clear and we all have to control medical costs.
So who should see a physical therapist directly? Any patient with significant trauma or a severe injury should go to the ER or a doctor, but an adult with mild to moderate muscle aches and pains, a runner with over-use injuries, or a welder with persistent muscle or joint issues can see a physical therapist to help determine the cause. If physical therapy is indicated, tissue tightness, muscle weakness or alignment disorders can be treated with modalities, exercise and manual mobilization of joints or soft tissues can be treated by law for up to 14 business days without a prescription from a physician. The treating physical therapist sends a report to the patient’s doctor, and if progress is not made, a physician consult is requested.
Working together – physicians and all physician extenders – we can serve our communities and our patients, offering the best care in the most cost effective manner possible.
Wayne A. MacMasters, PT, MSPT, is the president and founder of Tidewater Physical Therapy, Inc. Mr. MacMasters, a practicing physical therapist, received his undergraduate degree from the College of William & Mary and his Masters degree in Physical Therapy from Duke University.