As a consumer of medical care myself, it can be baffling trying to pick out a good medical provider. As shown in this article from Scientific American, many health care providers do a poor job adhering to “best-practice” standards. Many practitioners rely too heavily on the “art” of medicine which can lead to large inconsistencies, sub-optimal outcomes, and, frankly, a huge waste of the patient’s time. The article does a good job explaining what to look for in a physician, but what about selecting a physical therapist?
What is their education?
In order to become a physical therapist, an individual must attend a graduate level physical therapy program at an accredited school and then pass their license exam. As with any entry-level education, the schools do a great job providing students with the base of the best current knowledge on the subject taught. The problem is, once they get their license, future continuing education programs are not held to the same robust scientific standards. Physical therapists are required to attend continuing education with the intention of staying current, but those courses only have to “apply to physical therapy practice” and are not required to meet any kind of rigorous scientific review.
What are their certifications?
So this brings us to certifications. There are many, many different kinds of certifications out there for physical therapists. Most of them are essentially just made up credentials. A list of “alphabet soup” after someone’s name looks impressive, but it may not mean anything useful and may be an indicator that the practitioner is continuing their education through unscientific organizations. So how do you know what credentials are legitimate? Here is a quick reference:
- PT – When licensed, physical therapists receive some kind of PT designation. This may be just a good old fashioned “PT” or it could also be “MPT”/”MSPT” (Master of Physical Therapy) or “DPT” (Doctor of Physical Therapy). What’s the difference? Essentially nothing. It has to do more with when they got their degree. For the past 10-15 years the American Physical Therapy Association (APTA) has been transitioning to require all entry-level programs to provide the degree at the doctorate level. From now on, all new physical therapists get the “DPT” designation. Be wary of the one’s with something else (like me with my “PT” credential). It may have been awhile since they had any formal scientific training.
- _CS – The Clinical Specialist designation. There are eight of them for physical therapists – Sports (SCS), Orthopaedic (OCS), Neurologic (NCS), Women’s Health (WCS), Cardiovascular and Pulmonary (CCS), Clinical Electricophysiologic (ECS), Geriatric (GCS), and Pediatric (PCS). These are very important because these are the Board Certified Specialist designations. They are bestowed by the American Board of Physical Therapy Specialists (ABPTS) and require a very high standard of practice. ABPTS is linked directly to the APTA and requires an additional application process and rigorous exam.
- MS – Master of Science. Graduate level education at an accredited school.
- PhD, DSc, EdD – These are academic doctorates achieved through additional graduate level studies through an accredited school.
And that’s about it. What about other designations? They might be legitimate and even applicable to physical therapy (I have a CSCS for example – not on the above list) but they are not core certifications granted from the main governing body for physical therapists. Does it mean that these designations assure a scientific approach by the practitioner? Not necessarily, but it’s a good start.
Do they stay current on the medical literature?
Ask your physical therapist what journals they read regularly. There are several that pertain directly to the profession and others that relate to medicine as a whole. Your physical therapist should be following this flow of information. Want to test them? Ask your therapist for their favorite article from the last 3 months and how it has affected the way that they practice. They may have to think for a minute, but they should have something pretty quickly.
Do they contribute back to science?
You don’t really learn how something works until you participate. For example, I learn way more about a subject when I have to teach it than when I just take the course as a student. Is the physical therapist involved in the research community? Have they published peer-reviewed scientific papers (not just “fluff pieces” for the local media)? Have they served as a reviewer for a medical journal? Do they present and teach at APTA recognized conferences?
A good physical therapist will not only know the research that supports what they do, but they will know the actual researcher themselves. The research community is very open and willing to dialogue with clinicians – there is no reason that your physical therapist has not engaged them via email or personally at a conference.
Also, as a clinician becomes more aware of the research in their field, they become more confident with the words, “I don’t know.” This is a good sign! It shows confidence in what they DO know.
Do they contribute back to the profession?
The APTA guides the profession of physical therapy. Being a member is voluntary for physical therapists. By serving the APTA though the national association, specialist sections, or state chapters, physical therapists can be at the forefront of issues facing the professions – from practice to politics. Ask if your physical therapist has been involved at any level though committees or volunteering to teach.
Do they communicate well?
Does your physical therapist just do things without telling you why? Do they fail to make any sense to you when explaining things? Do they rush things along with little or no patient education? Even if they are 100% right in their approach, they may not be the best physical therapist for you.
This is a lot of information. How can I get this information simply without “grilling” my provider?
Easy. Ask for a curriculum vitae or “CV”. It will have their entire professional history in one document for you to review. Ours are provided openly on our website. Your physical therapist doesn’t have one? Run! And by all means, grill your provider. You are putting your health in their hands – be sure that they know exactly what they are doing.