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August/September 2002

By Kristi Ricks, MOT, OTR/L, and Jada Wright, MOT, OTR/L

PT vs OT

The debate between the philosophy and practice of occupational therapy and physical therapy is not a new one. The two professions have a history of battling each other in order to win turf wars and gain notoriety.

Susan Harris, PT, PhD, FAPTA, a well-known and often published physical therapist, stated in PT Magazine, “One of my goals for PT… is that we steal another page from the book of our OT colleagues (we’ve already ‘borrowed’ their long standing focus on function) and concentrate on client-centered or patient-centered practice.”1 As occupational therapists, we clearly understand that being client-centered is very important, and while we applaud their efforts, we have to wonder and worry about what PTs will steal from us next. It is essential that we take a stand and protect our profession and its philosophy.

Research on physical therapy’s enlarging focus revealed information that physical therapy is indeed preparing to expand its scope of practice to include “functional training in self-care and in home, community or work reintegration”—ideas that occupational therapy has always valued.2 Obviously, at a time when we are still trying to increase our visibility and define ourselves, we as OTs need to be concerned about this expansion for professional, intellectual, and economic reasons. While it is important that we protect our own jobs, perhaps the people we should be most concerned about are health care consumers. Physical therapy may add these words to their scope of practice, but neither their education, training, nor fundamental belief system supports it.3 Unfortunately, most consumers do not understand this gap and are likely to seek physical therapy services for reasons that are better addressed by occupational therapy.

PLAN OF ACTION

In the clinic, client-centered care is the priority and, in order to achieve treatment goals, the two professions must work collaboratively while still maintaining their own identities and beliefs. Since that collaboration is best begun at the educational level, we decided to develop a plan to address this important issue with students.

First, we had to compare and contrast the occupational therapy and physical therapy philosophy and practice by retrieving the scopes of practice, the guides of practice, codes of ethics, and emerging practice areas. These documents provided information about similarities and differences in the two areas.

Legislative and regulatory changes have greatly impacted this issue. Congress passed the Balanced Budget Act (BBA) of 1997, which affected health care in many ways. The BBA put health care on a prospective payment system, which has required practitioners to tailor their treatment outcomes to relate to function.4

There have also been some court rulings regarding physical therapy’s scope of practice. One case involved the Pennsylvania Physical Therapy Association (PPTA) and the Pennsylvania Chiropractic Society.5 The court sided with the PPTA in its argument that physical therapy is not a generic term and that it is prohibited by law to advertise physical therapy services unless those services are performed by a licensed PT.5 The PPTA clearly made an effort to protect their scope of practice from infringement by chiropractors.5 Ironically, PTs are trying to infringe on occupational therapy’s scope of practice.

In an article published in the January 2001 issue of OT Practice, AOTA’s state policy department said that state physical therapy chapters are attempting to introduce an expanded scope of practice legislation in 15 states.6 The scope would include functional training, which is unsupported by physical therapy education.6

STARTING WITH STUDENTS

Our next goal was to develop an informal quiz featuring questions on the differences in occupational therapy and physical therapy philosophy and practice to administer to students. We gave these quizzes to the health professions division (HPD) students at Nova Southeastern University (NSU), Fort Lauderdale, Fla.

Our goal was twofold. First, we wanted to gain insight on the level of understanding of occupational therapy among HPD students, while also increasing awareness of and appreciation for occupational therapy. Approximately 200 seven-item quizzes were randomly distributed to HPD students in the NSU cafeteria.

Physical therapy students found some of the questions controversial as they did ask specifically about physical therapy treatment and these students believed physical therapy’s scope of practice included cognitive and psychosocial treatment. Students in other disciplines did not have the same reaction to the questions or implied answers.

Ironically, the physical therapy students scored markedly lower on the quiz than students in other disciplines. As a group, the pharmacy students demonstrated the greatest level of understanding of occupational therapy based on the questions given. The results of the other quizzes were varied.

A Web board was also created to establish a communication line between the occupational therapy and physical therapy students. The board was designed to share ideas concerning occupational therapy and physical therapy practice and philosophy. Due to time constraints, we were unable to facilitate any discussion. However, the Web board is an ongoing entity at NSU that we hope will flourish even after this project ends. The goal is to encourage interdisciplinary discussions regarding assessment and treatment strategies through case studies.

The final step was to organize a presentation for physical therapy students. We met with the first year physical therapy students at NSU for an informal discussion that addressed their perceptions of and experiences with OTs. We explained our scope of practice, uniform terminology, and traditional as well as emerging practice arenas. We also gathered opinions about the idea of multiskilling therapists, based on a recent research article published in an occupational therapy journal.7 During the presentation, we encouraged more collaborative efforts and finally invited the class to participate in the Web board. Our presentation later inspired physical therapy students and faculty members to create more interaction between our disciplines by hosting a day of team-building activities.

THE BOTTOM LINE

Protecting occupational therapy beliefs today means job security tomorrow. We began this project with an agenda of vengeance. We set out to expose physical therapists as perpetrators and occupational therapy imitators. Less than halfway through the project, it became clear that an intellectual duel would be neither beneficial nor practical to our cause. We then directed our efforts to creating a more collaborative relationship between OTs and PTs at the student level that we hope will continue throughout our professional lives.

At a time when resources continue to decrease and the cost of care continues to increase, therapy practitioners must implement ways to maximize treatment time and dollars. We should learn early in our education that the most important agenda is that of our clients and in order to achieve their goals, it is essential that we work together while still maintaining our own identities and beliefs.

References

Harris S. Forecast 2000. PT Magazine. 2000;8(9):56.
Smith K. Legislative forecast: OTs challenge PT scope of practice expansion. OT Practice. 2000;5.
Standards of practice for occupational therapy. Available at: www.aota.org/general.otsp.asp. Accessed January 2001.
Goldstein M. The effect of the Balanced Budget Act on employment of physical therapists. PT Magazine. Available at: www.apta.org/pt_magazine/nov99/old/toc/htm. Accessed March 2001.
Tumolo J. “Physical therapy” a protected term in PA. Advance for PT. Available at: www.advanceforpt.org. Accessed March 2001.
Willmarth C. 2001 state legislative forecast. OT Practice. 2001;6:8.
Foto M. Multiskilling: Who, how, what, and why? Amer J Occup Ther. 1996;50:7-9.

Kristi Ricks, MOT, OTR/L, is a contract occupational therapist in Fort Lauderdale, Fla, and Jada Wright, MOT, OTR/L, is a supervisor at Independent Therapies Inc in Memphis, Tenn.

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