Simon and Garfunkel; Abbott and Costello; rehab therapists and physicians. What do these famous pairs all have in common? Despite being essential to one another’s success, the members of these dynamic duos have plenty of differences. And sometimes, those differences can spark some undue friction—especially if the parties lack a mutual understanding of one another. In the case of therapists and physicians, though, it’s the patients who ultimately pay the price for that friction. After all, when there’s a disconnect between a patient’s physician and his or her physical therapist, it can affect the patient’s attitude about therapy. He or she may question the therapist’s knowledge or techniques—or perhaps even wonder whether a doctor of physical therapy is a real doctor. If that’s not reason enough for rehab therapists and physicians to be on the same page, then I don’t what is.
For therapists and physicians to deliver better quality care and improved outcomes, they must fully understand and appreciate each other’s role in the care process. After all, it’s better to collaborate than to go it alone. To that end, here are six major differences between rehab therapists and physicians:
1. Physicians can determine medical diagnoses.
Okay, this one’s pretty obvious. As a rehab therapist, you already know that physicians are responsible for determining a patient’s medical diagnosis. However, while PTs, OTs, and SLPs cannot determine a medical diagnosis, they can determine a diagnosis that relates to their specific treatment plan—and that diagnosis is often crucial to developing an effective course of care. For example, a doctor may diagnose a patient with a cerebral infarction (i.e., a stroke), but during speech therapy, the patient’s speech-language pathologist may diagnose him or her with dysphagia and dysarthria. After all, the SLP is treating the patient not for the stroke, but for the impairments that directly resulted from the stroke.
2. Physicians can prescribe meds.
Again, this isn’t exactly breaking news. However, this particular difference between physicians and rehab therapists plays a major role in their vastly different approaches to patient care. Rehab therapists are more likely to provide non-invasive, hands-on treatment modalities, whereas physicians are more likely to prescribe meds or orthotic devices. For example, studies have found that PTs are far more likely than their physician counterparts to prescribe strengthening or stretching exercises. This is probably because therapists are trained to apply restorative, movement-based modalities that address the underlying cause of a patient’s complaints instead of treating—or even masking—his or her symptoms.
In all fairness, more physicians are choosing movement-based treatment over prescription meds these days—especially in light of the ongoing opioid crisis in the United States. But unless the physician refers a patient to the appropriate rehab therapist, there’s a good chance that patient’s movement-based care will end with a conversation about the importance of regular exercise. Therapists, on the other hand, actually prescribe specific exercises as a part of an evidence-based treatment plan—and then work directly with patients to ensure they understand how to perform those exercises on their own. This approach can be even more effective when supplemented with a cutting-edge, digitized, interactive home exercise program.
3. Physicians typically must complete more schooling.
Right now, all physicians are required to obtain a bachelor’s degree in biology or pre-med, complete a four-year postgraduate degree program in medicine, and top it all off by finishing a residency before they become licensed to practice medicine. But despite all that schooling, physicians typically study musculoskeletal pain and movement-based treatments for only a few weeks.
Conversely, PTs, OTs, and SLPs receive intensive training in their respective fields. Until recently, physical therapists could choose to complete either a master’s or doctoral degree in physical therapy. However, master’s degree programs in physical therapy have been phased out; new PT students must obtain a doctorate in physical therapy in order to obtain licensure in the United States.
For OTs and SLPs, the education requirements are a little different—but their education is still very specialized. Currently, occupational therapists and speech-language pathologists must obtain a master’s degree before they can be licensed. However, doctorate-level degrees in both fields have become more prevalent, and OTs and SLPs with doctorate degrees are eventually expected to be in the majority for both fields. Additionally, there are movements in fields focused on changing the educational requirements for OTs and SLPs. The Accreditation Council for Occupational Therapy Education (ACOTE) has mandated that only doctorate-level degree programs be eligible for ACOTE accreditation as of July 1, 2017. As for SLPs, while some professionals in the field believe a doctorate-level degree will be required eventually, there hasn’t been a strong organized effort to make that happen.
4. The success of rehab therapy treatment hinges on home participation.
Physicians typically deliver the bulk of treatment in the doctor’s office. But with rehab therapy, the real meat ’n’ potatoes of treatment occurs at the patient’s home and is contingent upon the patient’s adherence to his or her HEP. Unfortunately, when patients start therapy treatment for the first time, they’re often set up with the expectation that treatment occurs during their therapy appointments. This may be due to the fact that the average healthcare experience typically aligns with this expectation. (You get sick or injured; you go to your physician; the physician treats you in his or her office; then, you recover.) As a result, the task of educating patients about the importance of sticking to their prescribed home exercises falls on the therapist, and doing so could mean the difference between patients achieving their therapy goals and dropping out of therapy treatment altogether.
5. Rehab therapists can catch small problems before they turn into big ones.
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You may not have a crystal ball, but if you’re a rehab therapist, chances are you’ve got “The Sight”—well, the sight to spot injury risks, that is. As Dr. Alicia Ferriere, PT, DPT, FAFS, of Finish Line Physical Therapy states in this article for NBC News BETTER, “A physical therapist can pick out subtle postural habits that could predispose you to injury depending on your activity. Being aware of these habits, in addition to knowing how to work on them, gives [patients] the tools to stay injury-free all year-long.” Physicians, other other hand, are more likely to treat injury or reinjury after it has occured.
6. Therapists engage more intimately—and more often—with their patients.
Rehab therapists often tell me that one of the most rewarding aspects of their job is the connectedness they feel with their patients. After all, it’s hard not to bond with someone when you’ve spent weeks—or in some cases, years—guiding, championing, and celebrating his or her achievements and gains. And when therapists put a lot of focus on keeping patients engaged in therapy—whether that be through creative treatment approaches or the use of patient relationship management (PRM) tools—they are ideally positioned to act as true patient advocates. That’s not to say that physicians don’t bond with their patients, but the nature of medical treatment often means that patients don’t experience the same level of one-on-one involvement with their physicians as they do with their therapists.
Like the individuals who form most famous duos, PTs and physicians are great on their own, but they’re at their best when they work together. After all, both types of professionals are responsible for ensuring their patients achieve their health goals, and any provider worth his or her salt will be willing to collaborate in order to make that happen. With that in mind, it’s time for PTs, OTs, and SLPs to bridge those troubled waters with physicians and make sure that happens—together.