It’s Not About the Patient

If you have not yet viewed this video from Jack Bert, MD, from which the above screen shot was taken, please check it out now. Brace yourself. At the 8-minute mark, he discusses PT. He gets excited that a physician in SC was able to hire a chiropractor and “athletic trainers to do the PT” and bill for it, and ran 60% of the physical therapy business out of town.

Is there not some really big problem with this situation? Does this not border on breaking the law? The unrestricted medical license of physicians allows them to bill for whatever medical service they want. Thus, the athletic trainers can indirectly become physical therapists. As a licensed physical therapist in the state of SC, I wonder why I’m paying a fee for licensure, when the state could simultaneously allow non-licensed individuals to perform the service that I’m trained to provide. Why are consumers not being protected from this action?

In the comments on the site, which by now are littered with offended physical therapists, Jack Bert responds:

“Now that I have thought about this, the discussion on ancillary services really has nothing to do with physician arrogance or greed. It really has to do with what is best for the patient.”

I simply don’t buy it. How is having patients be treated by providers with less training and a different skill-set than PT’s (the athletic trainers) equate to something better for the patient. Yes, physicians do medicine. They do it well. Physical therapists, well we do rehab and do it well. Can’t we both exist together?

He goes on to suggest:

“For ancillary providers, such as physical therapists and chiropractors, to believe that they have the same training and ability to diagnose musculoskeletal pathology as a boarded orthopedist with a minimum of 5 years of post-medical school training, excluding a fellowship, is truly astounding.”

Perhaps Jack Bert is not aware of the body of research that suggests overall, that physicians are not adequately trained in musculoskeletal care either. In fact, I find it astounding that a general practitioner with little specific training on the subject finds themselves capable of diagnosing the specifics of an injured shoulder or neck. I fully agree that Jack Bert, a board certified, fellowship trained, orthopaedic surgeon has very capable musculoskeletal examination skills, but I also feel that his disregard of physical therapists to also have those skills offensive and reflective of an old-school physician mentality whose time has passed. There is research to support my claim. Physical therapists are musculoskeletal experts!

If this was truly about the patient, we would give the patients choices. We would empower them to choose their providers. We would act to reduce limited providers and wait times and work towards an equitable distribution of resources. There’s enough demand for everyone to play together. Comments like those of Jack Bert simply shed light on what these turf battles over physician-owned PT services and direct access restrictions are really about. It certainly isn’t about the patient.


About Eric Robertson

Dr. Eric Robertson, the founder of PTThinkTank.com and PTCoop.org, is an Assistant Professor of Physical Therapy at Regis University in Denver, CO. In addition to writing, he is a connoisseur of many things, ranging from coffee to bonsai trees. He specializes in orthopaedic manual physical therapy, radiology, evidence-based practice, and the impact of technology on healthcare.

 
 
  1. Jerry Durham 03/14/2011, 7:48 pm Reply

    Thanks for the post……this is so blatant. This video about Referral For Profit.

  2. Eric Furto 03/15/2011, 4:50 am Reply

    I agree with you “breaking the law” statement, Eric and almost feel that this will come to benefit the profession in some bizarre twist of fate at some time down the road. In the meantime, this needs to continue to go public. It needs to be put in front of CMS, insurance companies, and our lawmakers. Maybe a law is not truly being broken, but someone is getting stolen from here, and it surely not the Physicians. Great Post!

  3. Haideh 03/15/2011, 10:00 am Reply

    Thanks Eric for keeping this going! Not only is this a slap in the face of physical therapists, but other professionals should take offense to this lecture as well (podiatrists, chiropractors, ATC’s, etc). This should also be shared with all of our patients. An informed patient can also be our voice to legislators!

  4. Joel Heifferon 03/15/2011, 12:09 pm Reply

    “Referral For Profit”. It’s the same issues that were with the mortgage boom: too much refelction on profit and not enough about the customer. There has to be a balance.

  5. David Straight 03/15/2011, 2:09 pm Reply

    Would you really want a spine surgeon to manage your care? Well, I would say that depends. If they recommend a fusion, well, I am sure you have posts about that. http://www.bloomberg.com/news/2010-12-30/highest-paid-u-s-doctors-get-rich-with-fusion-surgery-debunked-by-studies.html

    The orthopods make the most money – there’s a good reason why. They own the most ancillary services and when they can mark things up 1700%, well, it’s no wonder. http://stoppopts.org/Physician-Dispensend-Pharmaceuticals.pdf

    This guy is a deluded opportunist that justifies his opinion with his MD title.

    It’s really a shame. He gives that vast majority of good doctors out there a really bad name.

  6. Gwen Simons 03/15/2011, 5:39 pm Reply

    Eric,

    I agree with everything you (and most others) have said. I’m not as upset about it, however. I think Dr. Bert just put himself on the radar screen for an audit or investigation. What goes around comes around . . . that’s what I always say.

  7. Lisa Furto 03/16/2011, 4:01 am Reply

    Thank-you for the post. I believe as physical therapists we need to work with medical schools to educate new graduates of the resources they have with other health professionals. We cannot expect an orthopedic surgeon to know how to diagnose movement dysfunction and know how to manage the rehabilitation process. They are trained to identify when a patient is appropriate for PT. From my understanding, PTs also learn more of the orthopaedic tests than MDs do in school. Which profession is doing the research on orthopaedic tests? It is not the role of the physician to dictate or monopolize medical care. It is their role to identify the appropriate treatment by the appropriate professional and refer. I would encourage anyone who reads this blog and has not become active communicating with your legislator to do so and contact their State section to learn what they can do. The time to make a difference is now.

  8. Zach Brezinka 04/06/2011, 3:57 pm Reply

    The original video appears to have been removed from the host site. Have there been any new statements from Dr. Bert, his group, or orthosupersite.com?