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A Vision for Society: Physical Therapy as Partners in the National Health Agenda
Katherine J. Sullivan, 1K.J. Sullivan, PT, PhD, FAHA, Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, and Center for Excellence in Teaching, University of Southern California, 1540 W Alcazar St, CHP-155, Los Angeles, CA 90089 (USA). *Address all correspondence to Dr Sullivan. Search for other works by this author on: 2J.G. Wallace Jr, PT, MS, BMS Reimbursement Management, Upland, California, and Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, University of Southern California. Search for other works by this author on: 3M.E. O'Neil, PT, PhD, Department of Physical Therapy and Rehabilitation Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania. Search for other works by this author on: 4G.M. Musolino, PT, MSEd, EdD, DCE, School of Physical Therapy and Rehabilitation Sciences, College of Medicine, University of South Florida, Tampa, Florida. Search for other works by this author on: 5M.B. Mandich, PT, PhD, Division of Physical Therapy, Professional and Undergraduate Degree Program, School of Medicine, West Virginia University, Morgantown, West Virginia. Search for other works by this author on: 6M.T. Studer, PT, MHS, NCS, CEEAA, Northwest Rehabilitation Associates, Salem, Oregon. Search for other works by this author on: 7J.M. Bottomley, PT, MS, PhD2, independent geriatric rehabilitation program consultant, advisor, and clinical educator in geriatric physical therapy, West Roxbury, Massachusetts. Search for other works by this author on: 8J.C. Cormack, PT, DPT, MSEd, NCS, DCE, Department of Physical Therapy and Office of the Chancellor, California State University, Long Beach, California. Search for other works by this author on: 9S.K. Nicholson, Esq, PT, MBA, MA, Quintairos, Prieto, Wood & Boyer, PA, Tampa, Florida, and Transitional Doctor of Physical Therapy Program, The Sage Colleges, Troy, New York. Search for other works by this author on: 10G.M. Jensen, PT, PhD, FAPTA, Graduate School; Academic Affairs; Department of Physical Therapy, School of Pharmacy and Health Professions; and Center for Health Policy and Ethics, Creighton University, Omaha, Nebraska. Search for other works by this author on:
Received:
21 October 2010
Published:
01 November 2011
The American Physical Therapy Association's (APTA's) Vision 2020 statement1 provided the stimulus our profession needed to develop a stronger self-awareness and broader public perception of physical therapy as a doctoring profession. Health service delivery in the United States is being refined and shaped by current sociopolitical events. In addition, changes in the demographics of our society, technological advances in medicine that continue to decrease mortality yet increase morbidity, and the critical need for more affordable health care will have an impact on the demand for physical therapy services.
In 2001, the Institutes of Medicine (IOM) recognized the urgent need for fundamental change in the American health care delivery system due to the existing "chasm" between the care delivered and the health of the children and adults who reside in the United States today,2 especially for those with developmental or acquired disability.3 On March 23, 2010, US President Barack Obama signed into law the Patient Protection and Affordable Care Act (Public Law 111–148) (PPACA).4 The PPACA focuses on the initial steps needed to reform a health care delivery and reimbursement system that is not consistently meeting the health needs of children and adults across the US population. Healthy People 2020 (HP2020) is the science-based, 10-year national public health agenda for improving the health of all Americans as determined by the US Department of Health and Human Services.5 Healthy People 2020 is the road map between the PPACA (the law that mandates health care reform) and the reform needed in both health services delivery and the national health-science research agenda.
There are unique opportunities for physical therapists to participate in the process of health care reform, which includes the stewardship of health care dollars. Through advances in the science and practice of physical therapy, physical therapists have earned the public's trust and recognition as health care professionals. The 2010–2011 edition of the US Department of Labor's Occupational Outlook Handbook 6 describes the physical therapist as part of the health care professional workforce, qualified to practice as one of the "health diagnosing and treating practitioners." Today, the public recognizes the essential value of physical therapy for episodic care provided within the current health care delivery system. However, we envision that the physical therapist of the future will provide primary care that includes rehabilitation, primary and secondary prevention, disease mitigation, and health promotion to protect the physical health and mobility of the population.
Currently, our profession confronts major challenges as our association responds and adapts to a changing, and yet to be defined, health care delivery and reimbursement system. Forty years ago, our professional leaders anticipated the need to advance professional preparation of the physical therapist to the clinical doctorate in order to prepare practitioners for direct access and autonomy of care. The short-term practice challenges we face today do not recuse us from preparing for the demands society will make on physical therapy in the next 40 years. As Jules Rothstein reminded our profession in 2002, the pursuit of direct access was not to ensure our professional autonomy but to "seek unfettered practice that allows us to use our skills, knowledge, and compassion to our maximal potential."7(p751) Physical therapy has earned the distinction as one of the health care professions; however, along with professional autonomy comes professional responsibility that includes the ethical and moral duty of a profession to meet the needs of the society that has granted that trust.
Health care professions are granted certain privileges in society, such as self-regulation and financial earning power, in exchange for meeting societal needs.8 Recognition of professional autonomy is not something the profession claims for itself but is bestowed upon the profession from society in exchange for meeting those societal needs. A fundamental, mutual expectation and shared understanding (quid pro quo) between health care professions and society is that health and health improvements are primary needs of our social contract with society.9 It is eminently important that every constituent group that represents the interests of the physical therapy profession, whether physical therapists or not, fully comprehend the rights, privileges, and responsibilities of this social contract.
Building upon the observations of others,10–14 this health policy perspective provides additional evidence that our profession must evolve beyond the tenets of Vision 2020. Through open discussion among our professional leaders, a new vision statement that is relevant to the challenges of today, yet prepares for the future, is a logical step in the evolution of physical therapy as a health care profession. Current events provide the impetus our profession needs to: partner in the national health agenda; respond to the societal need for accessible, affordable, and effective health care; and shape the future of physical therapist practice beyond 2020.
The objectives of this health policy perspective are to: (1) increase awareness—within our association and among practitioners, educators, and researchers—of the public expectation for the physical therapy provider workforce, (2) introduce the public health concepts of population-based, life-stage health promotion/risk reduction and individual life course management as a health and wellness model for physical therapy, and (3) describe the looming shortage in the physical therapy workforce and identify areas of educational reform needed to prepare an adequate number of qualified physical therapists and physical therapist assistants to meet the demand society will make on physical therapy in the next 40 years.
Returning to Our Historical Roots: Individual Health Services That Address Public Health Need
Within this decade, the profession will be called upon to address the demand for physical therapy health services that extend beyond our historical roots as one of the "allied health professions."15 Demographic and health care trends and the need to improve the nation's health without increasing health care costs will affect the future role of the physical therapist and physical therapist assistant.
The US Census Bureau's National Health Interview Survey* projects that starting in 2007 and extending to 2050, the population 65 years of age and older will outpace the rate of rise in the younger populations.16 The population 18 years of age will remain at 23% to 25%, and the populations 18 to 44 and 45 to 64 years of age are projected to decline. Starting in 2010, the population over 65 years of age is increasing from 12% to 13% to reach 20% of the total population by 2030 to 2050. For adults 65 years of age and older, decline in physical and cognitive ability increases the likelihood of progressive disability or increased risk of unintentional injury. With each decade, basic or complex activity limitations† progressively increase (percentages of people reporting activity limitations: 26% of those 65–74 years of age, 36% of those 75–84 years of age, and 62% of those 85 years of age and over).16
The decrease in the proportion of working-age adults compared with the increasing growth rate of the older-age sector has never been experienced in the US population. Affordable, accessible care for the younger populations is constrained due to the imbalance in health care resources consumed by the older population. The imbalance in health services delivered, compounded with the poor overall physical health of children and working-age adults today, has profound, long-standing implications for the health and wellness of younger populations. The most recent US health statistics highlight the poor physical health of children and adults. Childhood obesity affects approximately 12.5 million children and teens, with a prevalence of approximately 17% for children 2 to 19 years of age17 and with higher rates based on race or ethnicity.18 Obesity affects nearly 73 million adult men and women, with the prevalence of obesity at 32.2% among adult men and 35.5% among adult women.19 Furthermore, physical inactivity has reached unprecedented levels among children and adults of all ages. The range of physical inactivity varies by US region.20 A large proportion of American children and adults do not meet the minimum activity standards recommended by the Centers for Disease Control and Prevention (CDC).20 Yet, physical activity is a modifiable health behavior and one of the most effective health promotion and disease mitigation/prevention strategies to reduce multiple comorbidities, physical disability, and premature death.21
In our opinion, physical therapy has a professional responsibility to partner in several of the recently announced HP2020 objectives, particularly in the areas of safe physical activity across the life span, especially for children or adults with comorbid health conditions. However, one of the major objectives that should not be ignored by the physical therapy profession is to "promote the health and well-being of people with disabilities."5 Historically, physical therapy emerged as the health care profession that addressed the physical mobility needs of children and adults when disability resulted from injury (eg, World War I and II veterans) or disease (eg, survivors of paralytic poliomyelitis). Physical therapists are health care professionals trained to address the health consequences of pain, weakness, and impaired mobility through physical therapy interventions that are restorative and preventive. The unique value of physical therapy to societal health includes the following: (1) rehabilitation that returns working-age adults to preinjury or pre-illness function to resume participation in everyday activities such as employment or homemaking; (2) early intervention and home modification that prolongs safe, independent living in the home for the elderly population; (3) health risk monitoring with chronic disease management if needed when physical inactivity affects the physical health of young and middle-aged adults; (4) secondary prevention for physical health that includes safe, effective physical activity interventions for sedentary children or adults at risk for premature onset of chronic diseases and physical disability; and (5) education and screening that promote healthy lifestyles and the consequences of high-risk activity such as serious injury and disability in adolescents, teenagers, and young adults.
In our view, one of the greatest challenges for our professional and association leaders today is to combine our collective knowledge and experiences into one vision that defines our social contract between physical therapy and any child or adult who needs our care. A renewed vision will lead physical therapy beyond autonomy toward partnerships where our skills, knowledge, and compassion will merge with those of others to protect the health of the US population. In so doing, the value of physical therapy will be judged by our contribution to societal health, and any financial reward will be earned, and not demanded, by our profession.
Societal Needs Will Define Physical Therapy
Physical therapists are recognized by the public as practitioners in the areas of physical health and rehabilitation, as are chiropractors, occupational therapists, speech-language pathologists, athletic trainers, and exercise specialists.6 The scope of physical therapist practice as licensed health care professionals is distinct from our colleagues in rehabilitation or community-based exercise settings. Due to specialized professional training in movement dysfunction and physical health, physical therapists have unique knowledge, skills, and abilities that fulfill the qualifications and responsibility for health decisions across the continuum of health care delivery settings, from emergency department to long-term chronic care.
The clinical doctorate in physical therapy was a necessary evolution in the training of the physical therapy workforce. Physical therapists have knowledge in systems physiology and pathophysiology and the effects of disease or injury on human movement across the life span. Physical therapists determine the physiologic capacity, or lack of capacity, in the musculoskeletal, neuromuscular, cardiovascular, and integumentary systems in order to determine the activity limitations that interfere with age-expected movement and functional mobility.22
Diagnosis by a physical therapist is multidimensional because it is a synthesis of the consequences of movement dysfunction that results from disease or injury with the social and environmental determinants that affect health when mobility is limited. It is through this specialized diagnostic process, combined with knowledge of human health and development, that physical therapists can provide appropriate intervention to increase physiologic capacity of body movements needed to restore optimal function; promote motor development in children with sensorimotor developmental disabilities; prevent secondary complications due to pain, weakness, or immobility; and provide palliative care for a person with impaired mobility due to degenerative disease or the natural consequences of aging. Whenever a child or adult depends upon family or caregivers for assistance with activities of daily living or to provide physical care during the end stages of life, physical therapists provide patient- and family-centered care.23
A challenge for physical therapy is to envision physical therapist practice beyond our historical roots within the medical model of health service delivery. The medical model emphasizes the diagnosis and treatment of disease or injury for an individual; thus, physical therapist practice, within the medical model, has been constrained to episodic health events that are triggered by a change in health or functional status. In contrast, the public health model addresses population health; thus, the aim of public health is to prevent disease or injury at the community level rather than to treat or cure disease.5 One of the priorities for HP2020 is to engage health care practitioners with the local community so that preventive services such as risk monitoring or early disease detection can occur, mitigating the need for more costly disease management or emergency care.
It is our view that a life stage approach to physical health is an ideal primary and secondary risk management and health promotion model for physical therapy. The change in movement capacity and capability that occurs naturally across the life stages provides a framework for individual life course management of a person. A life course approach to physical health can be used to identify when physical therapy services are needed. In other words, when disease or injury limits, or puts at risk, age-expected mobility or physical function, physical therapy services are indicated.
Life stages are the chronological age ranges, as defined by the CDC, that are correlated with typical age-related health behaviors and health risks.24 Each life stage is associated with positive determinants that influence health status (ie, adoption of increased activity as a health promotion behavior) or health risks that can lead to unintentional injury or the accumulation of chronic conditions with age. Life stage categories are an effective framework to anticipate health risk by chronologic age. The Figure presents a life stage, health, and wellness model for physical therapy. Physical health risks are unique to each life stage; thus, appropriate life stage health promotion and risk reduction strategies can be incorporated into the physical therapy plan of care to protect physical health. Health promotion and risk reduction efforts can prevent premature onset of disability or protect the health of people with disability at any time throughout the life stages.
Figure
Role of physical therapy in physical health promotion, disease mitigation, and injury prevention by life stage: age-related health risk by chronologic age. Source of data: Centers for Disease Control and Prevention. Life Stages and Specific Populations. Available at: http://www.cdc.gov/LifeStages/. Accessed May 3, 2011.
Figure
Role of physical therapy in physical health promotion, disease mitigation, and injury prevention by life stage: age-related health risk by chronologic age. Source of data: Centers for Disease Control and Prevention. Life Stages and Specific Populations. Available at: http://www.cdc.gov/LifeStages/. Accessed May 3, 2011.
The life course approach, introduced by the World Health Organization, is a framework to assess the effects of environment or other physical and social determinants that affect the health outcome for an individual across the life span.25 Development is a lifelong process that extends over a person's individual life course, from birth throughout the aging process to death. Thus, health outcomes over the life course are influenced by the positive or negative influences of health determinants (ie, contextual factors in the International Classification of Functioning, Disability and Health)26 such as lifestyle choices, socioeconomic status, access to adequate and appropriate care, accelerated decline of health due to accumulated disease or injury over a person's life, and other social factors.
Maintenance of healthy, age-appropriate mobility for children or adults with or without physical disability is an important aspect of population health that can be influenced by physical therapy. Physical therapy is indicated when any health condition results in movement-related impairments, restricts physical activity, or prevents participation in usual age-expected social roles. In the Table, CDC population-based data are presented by life stage. Population-based data are used to determine the percentage of the total population who report movement problems or restricted mobility. The most prevalent health conditions by life stage associated with mobility limitations are listed. A life course approach to physical therapy care extends our role from rehabilitation providers within the medical model to partners in health promotion and disease prevention, which incorporates the principles of public health. The health conditions listed in the Table are population based and do not represent the prevalence of actual health conditions seen in physical therapist practice. The population-based percentages can be used to estimate the actual or at-risk number of children and adults in a local community with mobility limitations.
Table
Percentage of Children or Adults With Movement-Related Activity Limitations and Associated Health Condition by Life Stage a
| Life Stage | Percentage of Total Population With Movement-Related Activity Limitation | Activity Limitation b or Movement Dysfunction | Associated Health Risk (Disease or Injury) c Ranked Highest to Lowest |
|---|---|---|---|
| Infants (0–3 years of age) | 1.90% | Developmental motor delay, impaired arm or leg movement, unable to control head or trunk, difficulty moving arms or legs | Rank order of developmental disabilities:
Rank order of injury:
|
| Children (3–5 years of age) | 3.80% | Developmental delay or difficulty walking, running, or playing | |
| School-aged (6–14 years of age) | 4.40% | Difficulty walking or running, use of an assistive device, or assistance in selfcare | Rank order of musculoskeletal and neuromuscular injury from:
|
| Adolescence (15–17 years of age) | 5.0% (estimated) | Unable to perform or limited performance in age-expected functions | |
| Working-age adults (18–64 years of age) | 5.1% of 18- to 44-year-old age group 18.1% of 45- to 64-year-old age group | Unable to perform or limited performance in work-related or homemaking activities | Rank order:
|
| Older adults (65–74 years of age) | 28.6% | Limitations in mobility or assistance needed in activities of daily living or instrumental activities of daily living | Rank order:
|
| Senior and frail adults (≥75 years of age) | 45.3% | Unable to live independently at home |
| Life Stage | Percentage of Total Population With Movement-Related Activity Limitation | Activity Limitation b or Movement Dysfunction | Associated Health Risk (Disease or Injury) c Ranked Highest to Lowest |
|---|---|---|---|
| Infants (0–3 years of age) | 1.90% | Developmental motor delay, impaired arm or leg movement, unable to control head or trunk, difficulty moving arms or legs | Rank order of developmental disabilities:
Rank order of injury:
|
| Children (3–5 years of age) | 3.80% | Developmental delay or difficulty walking, running, or playing | |
| School-aged (6–14 years of age) | 4.40% | Difficulty walking or running, use of an assistive device, or assistance in selfcare | Rank order of musculoskeletal and neuromuscular injury from:
|
| Adolescence (15–17 years of age) | 5.0% (estimated) | Unable to perform or limited performance in age-expected functions | |
| Working-age adults (18–64 years of age) | 5.1% of 18- to 44-year-old age group 18.1% of 45- to 64-year-old age group | Unable to perform or limited performance in work-related or homemaking activities | Rank order:
|
| Older adults (65–74 years of age) | 28.6% | Limitations in mobility or assistance needed in activities of daily living or instrumental activities of daily living | Rank order:
|
| Senior and frail adults (≥75 years of age) | 45.3% | Unable to live independently at home |
a Sources of data: (1) Centers for Disease Control and Prevention. Life Stages and Specific Populations. Available at: http://www.cdc.gov/LifeStages/. Accessed May 3, 2011; (2) Disability and Health in the United States, 2001–2005. Hyattsville, MD: Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2008; and (3) Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2009 (8/2010). Available at: http://www.cdc.gov/nchs/data/series/sr_10/sr10_248.pdf. Accessed March 3, 2011.
b For children, limited ability to walk, care for themselves, or perform any other age-expected activities. For adults, limitations in basic movements that require the use of an assistive device (ie, crutch, cane, walker, or wheelchair) or the physical assistance of another person to complete basic or complex activities of daily living.
c Health conditions where mobility is limited due to secondary consequence of cardiac, cardiopulmonary, or other systemic diseases cannot be readily extracted from Centers for Disease Control and Prevention sources.
Table
Percentage of Children or Adults With Movement-Related Activity Limitations and Associated Health Condition by Life Stage a
| Life Stage | Percentage of Total Population With Movement-Related Activity Limitation | Activity Limitation b or Movement Dysfunction | Associated Health Risk (Disease or Injury) c Ranked Highest to Lowest |
|---|---|---|---|
| Infants (0–3 years of age) | 1.90% | Developmental motor delay, impaired arm or leg movement, unable to control head or trunk, difficulty moving arms or legs | Rank order of developmental disabilities:
Rank order of injury:
|
| Children (3–5 years of age) | 3.80% | Developmental delay or difficulty walking, running, or playing | |
| School-aged (6–14 years of age) | 4.40% | Difficulty walking or running, use of an assistive device, or assistance in selfcare | Rank order of musculoskeletal and neuromuscular injury from:
|
| Adolescence (15–17 years of age) | 5.0% (estimated) | Unable to perform or limited performance in age-expected functions | |
| Working-age adults (18–64 years of age) | 5.1% of 18- to 44-year-old age group 18.1% of 45- to 64-year-old age group | Unable to perform or limited performance in work-related or homemaking activities | Rank order:
|
| Older adults (65–74 years of age) | 28.6% | Limitations in mobility or assistance needed in activities of daily living or instrumental activities of daily living | Rank order:
|
| Senior and frail adults (≥75 years of age) | 45.3% | Unable to live independently at home |
| Life Stage | Percentage of Total Population With Movement-Related Activity Limitation | Activity Limitation b or Movement Dysfunction | Associated Health Risk (Disease or Injury) c Ranked Highest to Lowest |
|---|---|---|---|
| Infants (0–3 years of age) | 1.90% | Developmental motor delay, impaired arm or leg movement, unable to control head or trunk, difficulty moving arms or legs | Rank order of developmental disabilities:
Rank order of injury:
|
| Children (3–5 years of age) | 3.80% | Developmental delay or difficulty walking, running, or playing | |
| School-aged (6–14 years of age) | 4.40% | Difficulty walking or running, use of an assistive device, or assistance in selfcare | Rank order of musculoskeletal and neuromuscular injury from:
|
| Adolescence (15–17 years of age) | 5.0% (estimated) | Unable to perform or limited performance in age-expected functions | |
| Working-age adults (18–64 years of age) | 5.1% of 18- to 44-year-old age group 18.1% of 45- to 64-year-old age group | Unable to perform or limited performance in work-related or homemaking activities | Rank order:
|
| Older adults (65–74 years of age) | 28.6% | Limitations in mobility or assistance needed in activities of daily living or instrumental activities of daily living | Rank order:
|
| Senior and frail adults (≥75 years of age) | 45.3% | Unable to live independently at home |
a Sources of data: (1) Centers for Disease Control and Prevention. Life Stages and Specific Populations. Available at: http://www.cdc.gov/LifeStages/. Accessed May 3, 2011; (2) Disability and Health in the United States, 2001–2005. Hyattsville, MD: Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2008; and (3) Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2009 (8/2010). Available at: http://www.cdc.gov/nchs/data/series/sr_10/sr10_248.pdf. Accessed March 3, 2011.
b For children, limited ability to walk, care for themselves, or perform any other age-expected activities. For adults, limitations in basic movements that require the use of an assistive device (ie, crutch, cane, walker, or wheelchair) or the physical assistance of another person to complete basic or complex activities of daily living.
c Health conditions where mobility is limited due to secondary consequence of cardiac, cardiopulmonary, or other systemic diseases cannot be readily extracted from Centers for Disease Control and Prevention sources.
Preparing the Physical Therapy Workforce to Meet Frontline Care Demands
Rapid, dynamically changing trends in public health, health services delivery, and health care reimbursement will shape the future of the physical therapy profession. One of the high-priority objectives of HP2020 is to decrease health disparities by increasing access to health services. Health disparities are the differences in individual or regional community health due to lack of access, high cost, or other factors that create barriers to health services. The insufficient numbers of primary care physicians27–29—as well as regulations that limit access to other qualified health care professionals—are compounding health disparities.30,31
Opportunities for innovation in the US health delivery system are receiving high priority as a direct result of the PCACA and HP2020.32,33 Alternative solutions to health delivery that include interprofessional approaches to community health are proving to be more effective for people with chronic diseases, especially in older populations.27,34,35 Health care practitioners, including physical therapists, will be called upon to provide "frontline care services" in state-designated rural or other frontline care scarcity areas or for special populations that are chronically underserved.36 Concern over growing health disparities and inadequate medical management of chronic health conditions, along with the primary care physician shortage, has resulted in physician leaders speaking out to abandon the long-standing opposition to nonphysician practitioners as primary care providers in order to increase access to affordable care.28,37
Critical Need: Prepare an Adequate Workforce of Qualified Physical Therapy Providers
The US Bureau of Labor Statistics' projections for the physical therapy workforce are daunting.6 Data from the US Bureau of Labor Statistics' National Employment Matrix indicate that in 2008 there were 185,500 physical therapists and 63,800 physical therapist assistants employed in the US health care provider workforce.6 The US Department of Labor projects a need for 242,000 physical therapists and 85,000 physical therapist assistants in the workforce by 2018.6 These projections equate to a 30% to 35% increase in the physical therapy provider workforce within the next 8 years.
Other licensed health care professional groups such as pharmacists, nurses, dentists, and physician assistants are actively engaged in efforts to participate in solutions to address both the health disparities and workforce shortage in their respective professions.30,38 Dynamic reform of the professional education of physical therapists and the education of physical therapist assistants is needed now. More importantly, physical therapy must take a deliberative look at the expectations the profession should have of itself as a doctoring profession in order to prepare our practitioners for contemporary practice expectations. Our profession has the responsibility to prepare an adequate, qualified workforce of both physical therapists and physical therapist assistants to provide the care that the public needs. According to the US Department of Labor6:
Changes to restrictions on reimbursement for physical therapy services by third-party payers will increase patient access to services and, thus, increase demand. The increasing number of people who need therapy reflects, in part, the increasing elderly population. The elderly population is particularly vulnerable to chronic and debilitating conditions that require therapeutic services. These patients often need additional assistance in their treatment, making the roles of assistants and aides vital. In addition, the large baby-boom generation is entering the prime age for heart attacks and strokes, further increasing the demand for cardiac and physical rehabilitation.
Medical and technological developments should permit an increased percentage of trauma victims and newborns with birth defects to survive, creating added demand for therapy and rehabilitative services.
Physical therapists are expected to increasingly use assistants and aides to reduce the cost of physical therapy services. Once a patient is evaluated and a treatment plan is designed by the physical therapist, the physical therapist assistant can provide many parts of the treatment, as directed by the therapist.
The Access to Frontline Health Care Act of 2011 (HR 531)36 is an example of proposed legislation to bring health care personnel, such as physical therapists, to underserved areas. It is one example of society's readiness to prioritize health for children and adults in the United States provided by any qualified health care practitioner. Our profession can participate with clinical professionalism and responsibility to shape our future in health reform, not only as autonomous providers of physical therapy services but also as partners with other professionals committed to community health.37
Our profession has much to offer our communities, such as preventative, restorative, and protective health services for children and adults with episodic or chronic functional limitations that restrict their ability to live productive lives and to participate in age-expected societal roles. However, our professional experience to date has been shaped by the current US health care delivery and reimbursement system, which has created a culture of professional competition, failing both health practitioners and the health of the US population. Physical therapists have been constrained by our place in the medical, fee-for-service reimbursement system; thus, the priorities of APTA and special interest groups within the association should be balanced between the practice challenges of today and the need to prepare physical therapists for future practice as frontline primary care providers. According to the Kaiser Family Foundation (a non-profit health care think tank),39 primary care includes first contact for any health issue that provides a long-term, person-focused, comprehensive health management plan that includes the coordination of care with referral to another health care provider when care must be received elsewhere (ie, with a specialist).
Due to the provisions of the PPACA and the goals of HP2020,5 the profession has an immediate opportunity to define a primary care model for physical therapy. A primary practice model for physical therapy would include the essential elements of physical therapist practice for individual and interprofessional approaches to community health. Primary care provided by a physical therapist is not management of medical conditions; instead, it is a long-term, person-focused, comprehensive health management plan that includes annual visits to address the physical health needs of a person or a family. Primary care by a physical therapist would be especially beneficial for children or adults with chronic health conditions, particularly those who are physically disabled and at risk for poor health due to mobility and activity limitations.
Most importantly, a primary care model for physical therapy would allow physical therapists to assume the direct health monitoring of people with disability—a specific health disparity group that receives little or no comprehensive care today. Annual visits would include health promotion, disease mitigation, and age-related risk reduction that are associated with life course management. Thus, the frontline primary care physical therapist is more than a generalist. We envision the frontline physical therapist as a specialist in life course management and primary care with the diagnostic skills to recognize when change in health status necessitates referral to another health care provider, including referral to a board-certified clinical specialist in physical therapy.
Critical Need: Reform Professional Doctorate in Physical Therapy to Prepare for Frontline Care
Changes in the academic curricula are a high priority if we are to prepare physical therapists for frontline primary care. It may be time to reconceive the current Guide to Physical Therapist Practice 22 and balance the diagnosis and treatment medical model approach with the principles of public health and life course management. The Guide to Physical Therapist Practice emphasizes the medical, health-related systems physiology that physical therapists need as health care professionals; however, it does not address the life course management and health monitoring skills that the frontline primary care physical therapist will need for future practice demands.
Equally important is the immediate need to update the curriculum and educational requirements for today's physical therapist assistant (PTA). The knowledge, skills, and abilities of the PTA must be advanced to assist and extend physical therapy services provided by a physical therapist. A tiered physical therapy workforce would provide career paths from post–high school community college for entry into a therapy-related health career to the development of baccalaureate and postbaccalaureate certificate programs that prepare the PTA for licensure (eg, educational preparation of the licensed physician assistant as supportive health care provider to the licensed physician).
It is our perspective that graduates with a clinical doctorate in physical therapy must be prepared to provide frontline care across a wide range of fundamental health-related skills and to develop strategies to distribute these professionals to areas of great need. Societal demands, which are upon us now, provide a chance for collective agreement within our profession to define the foundational skills for musculoskeletal, neuromuscular, cardiovascular, and integumentary health across the life span needed by today's doctor of physical therapy. The time has come to further standardize the essential elements of physical therapist practice such as assessment of physiologic systems (ie, musculoskeletal, neuromuscular, and cardiovascular) and the effects of reduced capacity on age-expected movement and functional task performance. The life course perspective emphasizes the commonality of all physical therapists: to ensure that people of all ages live healthy, active, and productive lives with optimal function. Our society will need physical therapists as primary care providers within local communities as an affordable, effective option for health care that returns young and middle-aged adults to productive school, home, and work activity and to mitigate disease and prevent unintentional injury for our older population as physical health declines with age. Our society depends on a healthy, active, and productive young population along with a protected older population; primary care physical therapy provides an affordable option to address the physical health needs of the US population.
Curricular changes in physical therapist and physical therapist assistant education programs must be driven by shared, informed decision making between academic and clinical educators and employers and physical therapy care providers to ensure that the challenges and demands of the physical therapist practice settings are not overlooked by the academic institutions. University leadership is needed for the advancement of research and specialty practice; however, the primary care needs of the population are unique to today's health care environment and practice demands. Therefore, our practitioners on the front line have a perspective that is critical if knowledge gained from research is to result in pragmatic applications in the clinic.40,41
Conclusion
In her 2000 McMillan Lecture, Dr Ruth Purtilo predicted the challenges that our profession must address today:
In short, societal critics call us to a partnership that accepts constraint and makes prudent use of resources in the name of the common good of the human community. It is up to us to take society's concerns seriously under advisement…. The very core of being professional demands it, and it is key to survival in the new millennium.42(p1119)
As our professional leaders of the past have done before us, the leaders of our professional association today have the privilege and responsibility to shape the future of physical therapy.
Little did we realize that the PPACA may provide our profession the opportunity to bridge a part of the gap in the "chasm" of health service delivery to improve the health of our nation. A vision for physical therapy that focuses on the needs of society will guide our profession toward practice that is patient and community centered. The value of physical therapy will be judged by the effectiveness that physical therapy contributes to the health of the nation and the vision of HP2020: "A society in which all people live long, healthy lives."5
The authors acknowledge the perspectives shared by Helen Hislop, PT, PhD, FAPTA, and Charles Magistro, PT, FAPTA, during manuscript development; their lifelong leadership has significantly contributed to the foundation that supports the science and practice of physical therapy today.
* Demographic trends or medical health condition incidence and prevalence rates are recent estimates from the ongoing, cross-sectional, in-person household National Health Interview Survey of the civilian, noninstitutionalized US population.
† Basic movement activity limitations include unable or needs assistive device to walk, stand, sit, bend or kneel, reach overhead, grasp objects with fingers, and lift. Complex activity limitations include unable or needs assistance of another person to complete self-care or other activities required to live independently in the home such as shopping, cooking, and taking care of bills.
References
1
APTA Vision Sentence and Vision Statement for Physical Therapy 2020
.
.
2
Institute of Medicine of the National Academies
.
Crossing the Quality Chasm: A New Health System for the 21st Century
.
Washington, DC
:
The National Academies Press
;
2001
.
3
Field
MJ
, Jette AM
Committee on Disability in America
.
The Future of Disability in America
.
Washington, DC
:
The National Academies Press
;
2007
.
4
Patient Protection and Affordable Care Act, HR 3590, 111th Congress 2010, Pub L 111–148
.
.
5
US Department of Health and Human Services
.
Healthy people 2020
.
.
6
US Department of Labor, Bureau of Labor Statistics
.
Occupational Outlook Handbook, 2010–2011 edition
.
.
7
Rothstein
JM
.
Editor's note: Autonomy and dependency
.
Phys Ther
.
2002
;
82
:
750
–
751
.
8
Cruess
RL
, Cruess SR
Expectations and obligations: professionalism and medicine's social contract with society
.
Perspect Biol Med
.
2008
;
51
:
579
–
598
.
9
Stone
JR
.
Saving and ignoring lives: physicians' obligations to address root social influences on health: moral justifications and educational implications
.
Camb Q Healthc Ethics
.
2010
;
19
:
497
–
509
.
10
Kigin
CM
, Rodgers MM Wolf SL
for the PASS Steering Committee Members
.
The Physical Therapy and Society Summit (PASS) meeting: observations and opportunities [erratum in: Phys Ther. 2010;90:1906]
.
Phys Ther
.
2010
;
90
:
1555
–
1567
.
11
DeJong
G
.
Bundling acute and postacute payment: from a culture of compliance to a culture of innovation and best practice
.
Phys Ther
.
2010
;
90
:
658
–
662
.
12
Craik
RL
.
Editorial: a responsibility to put "health policy in perspective."
Phys Ther
.
2009
;
89
:
1114
–
1115
.
13
Sahrmann
SA
.
Invited commentary on "The Physical Therapy and Society Summit (PASS) Meeting…," Kigin CM, Rodgers MM, Wolf SL; for the PASS Steering Committee Members: Phys Ther. 2010;90:1555–1567
.
Phys Ther
.
2011
;
91
:
432
–
433
.
14
Childs
JD
, Whitman JM Sizer PS
A description of physical therapists' knowledge in managing musculoskeletal conditions
.
BMC Musculoskelet Disord
.
2005
;
6
:
32
.
15
Campion
F
.
The AMA historical archives
.
.
16
Centers for Disease Control and Prevention
.
Health, United States, 2009, with special feature on medical technology
.
.
17
Centers for Disease Control and Prevention
.
Prevalence of obesity among children and adolescents: United States, trends 1963–1965 through 2007–2008
.
.
18
Ogden
CL
, Lamb MM Carroll MD Flegal KM
Obesity and socioeconomic status in children and adolescents: United States, 2005–2008
.
NCHS Data Brief
.
2010
;(
51
):
1
–
8
.
19
Flegal
KM
, Carroll MD Ogden CL Curtin LR
Prevalence and trends in obesity among US adults, 1999–2008
.
JAMA
.
2010
;
303
:
235
–
241
.
20
Centers for Disease Control and Prevention
.
Physical inactivity estimates, by county
.
.
21
Rimmer
JH
, Rauworth AE Wang EC
A preliminary study to examine the effects of aerobic and therapeutic (nonaerobic) exercise on cardiorespiratory fitness and coronary risk reduction in stroke survivors
.
Arch Phys Med Rehabil
.
2009
;
90
:
407
–
412
.
22
American Physical Therapy Association
.
Interactive Guide To Physical Therapist Practice online
.
.
23
Guion
WK
, Mishoe S Passmore GG Witter P
Development of a concept map to convey understanding of patient and family-centered care
.
J Healthc Qual
.
2010
;
32
:
27
–
32
.
24
Centers for Disease Control and Prevention
.
Life stages and specific populations
.
.
25
Aboderin
I
, Kalache A Ben-Shlomo Y
Life course perspectives on coronary heart disease, stroke and diabetes: key issues and implications for policy and research
.
.
26
International Classification of Functioning, Disability and Health: ICF
.
World Health Organization
:
Geneva, Switzerland
;
2001
.
27
Yarnall
KS
, Ostbye T Krause KM
Family physicians as team leaders: "time" to share the care
.
Prev Chronic Dis
.
2009
;
6
:
A59
.
28
Jacobson
PD
, Jazowski SA
Physicians, the affordable care act, and primary care: disruptive change or business as usual?
J Gen Intern Med
.
2011
April
01
[Epub ahead of print]
.
29
US Department of Health and Human Services, Health Resources and Services Administration
.
Designated health professional shortage areas (HPSA) statistics
.
.
30
Reinhard
SC
, Kassner E Houser A
How the Affordable Care Act can help move states toward a high-performing system of long-term services and supports
.
Health Aff (Millwood)
.
2011
;
30
:
447
–
453
.
31
Rosenbaum
S
, Teitelbaum J Hayes K
Realizing health reform's potential, the essential health benefits provisions of the Affordable Care Act: implications for people with disabilities
.
Issue Brief (Commonw Fund)
.
2011
;
3
:
1
–
16
.
32
Gray
BJ
, Sullivan KC
Provisions in the Patient Protection and Affordable Care Act (PPACA)
.
Hauppauge, NY
:
Nova Science Publishers Inc
;
2011
.
33
US Department of Health and Human Services, Agency for Healthcare Reasearch and Quality
.
Innovations exchange
.
.
34
McLaughlin
DB
.
Responding to Healthcare Reform: A Strategy Guide for Healthcare Leaders
.
Chicago, IL
:
Health Administration Press
;
2011
.
35
Kocher
R
, Emanuel EJ DeParle NA
The Affordable Care Act and the future of clinical medicine: the opportunities and challenges
.
Ann Intern Med
.
2010
;
153
:
536
–
539
.
36
Access to Frontline Health Care Act of 2011, HR 531, 112th Cong, (2011–2012)
.
.
37
Darzi
A
.
A time for revolutions: the role of clinicians in health care reform
.
N Engl J Med
.
2009
;
361
:
e8
.
38
Centers for Disease Control and Prevention
.
Health, United States, 2010: at a glance table
.
.
39
Kaiser Family Foundation
.
Health policy explained: primary care shortage
.
.
40
Graham
ID
, Logan J Harrison MB
Lost in knowledge translation: time for a map?
J Contin Educ Health Prof
.
2006
;
26
:
13
–
24
.
41
Sullivan
KJ
.
Translational rehabilitation research: from science to practice and practice to science
.
J Neurol Phys Ther
.
2010
;
34
:
119
–
121
.
42
Purtilo
RB
.
Thirty-First Mary McMillan Lecture: a time to harvest, a time to sow; ethics for a shifting landscape
.
Phys Ther
.
2000
;
80
:
1112
–
1119
.
© 2011 American Physical Therapy Association
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