Changes afoot for Georgia’s physical therapy industry

On his journey into the field of physical therapy:

“I studied psychology in the 1970s. As part of that psychology program I was introduced to a lot of things that were considered alternative at the time like yoga, tai chi and acupuncture. That’s cutting edge now, and I was introduced to those things as a way to address stress and anxiety in the 1970s. And I became more interested in pain and treatment of musculoskeletal pain. So I went into PT with this background in what at that time was considered alternative medicine and what is now considered complimentary medicine. And what I wanted to use my PT for was to explain or to learn why things like yoga, tai chi and acupuncture worked. And that’s what I still do. I’m still working on the science behind all of those complimentary, alternative treatments. I incorporate that into a very traditional PT practice. …I went on to get a research doctorate to better understand those things.”

On the allure of the physical therapy field:

“In physical therapy, you learn how the body functions with the neurological system and the musculoskeletal system. Psychology is more of a qualitative kind of thing. There aren’t a lot of measurements that you can take. Physical therapy is more quantitative. You look at the science and the biology and physiology that take place with a lot of interventions. You hear people say, ‘I went and got a massage and feel better.’ Well, why do people feel better after that? ‘I started meditating, and I think it’s a good thing to do.’ Is it just you thinking it’s a good thing to do, or is it a measurable thing? In physical therapy, we learn about all of the ways of measuring the brain, the nervous system and the musculoskeletal system. It allowed me access to a very unique perspective on measuring how all of these things work. I spend my day thinking about what all of these different interventions actually do to people.”

Dr. Rhett Roberson, PT, DPT, OCS, CERT. SMT

The Sports Rehabilitation Center

On how he discovered physical therapy as a career:

“I actually got my start in undergraduate when I was kind of searching for what career would suit me best. I was looking back on my personal experiences and playing sports. In high school I played baseball and football. I had a shoulder injury with a small tear on my rotator cuff. I had some PT myself. I was fortunate enough to have an excellent physical therapist. He spent quite a lot of time with me trying to rehab me and get me back onto the field. And I was always impressed with the wealth of knowledge he had. Back then physical therapy wasn’t something that I thought I’d be interested in as a career. But as I reflected on it, I thought it be something worth looking into. So I started doing volunteer work around town and in Athens. I then went into a position with Gwinnett Medical Center doing PT aid work, and I loved it. I really enjoyed the whole experience. So I got into my major classes and started going through the process of getting into school.”

On what keeps him passionate about his work:

“It’s very rewarding to come to work and know that you’re going to be helping people throughout the course of the day. It’s not something that everyone gets to experience when they go to work. So I feel very fortunate. I specifically work with athletes now as well as your average everyday person. My patients span the spectrum of life from early teenage years to the early 90’s. I wouldn’t say one particular population is more rewarding to work with than another. It’s all very relative. An athlete that wants to get back on the field to feel complete and whole in their own life is just as important as someone wanting to get back to their occupational duties of any kind.”

Dr. Joseph Donnelly, PT, DHS, OCS

Clinical associate professor and director post-professional programs in the Department of Physical Therapy of Mercer University

On how he developed an interest in physical therapy:

“My oldest sister, Ellen, has cerebral palsy. I’m the youngest of seven, and we used to all go to her physical therapy sessions. As a little tyke, I really enjoyed it. Then when I graduated from high school, I took a year off between high school and college and I did some volunteer work in a hospital and got ignited about the physical therapy field. Getting people moving again and back to their everyday lives was exciting. I had played high school tennis and was pretty athletic and felt a passion for orthopedics and getting people back into sports and back into function. …I went to Daemen College in Amherst, New York, and I have a baccalaureate degree in physical therapy. I worked in acute care for a few years in a hospital, and then I did my masters in orthopedic physical therapy at the University of Pittsburgh.”

On moving toward the academic side of PT:

“I think it began back in early 2000 as I became exposed to students in the clinic. I just felt there was something missing. If I was going to change things, I knew I needed to get into the education realm and help facilitate that change in their clinical reasoning abilities and their compassion and caring for patients. On the academic end, we have a very strong commitment to the clinical reasoning process, which is a collaborative process between the physical therapist and their patients. The patient is the main center of the process and that we need to advocate for them. Physical therapists get to spend a lot of time with their patients, so they’re able to develop a more professional-personal relationship with them. We tend to act as not only their healthcare provider, but also as their coach to get them to return to function and to help them problem solve. …It’s amazing to be in this profession for 31 years and still have the motivation toward educating future physical therapists to improving the function in my fellow human beings.”

Highlights of the new law

As president of the Physical Therapy Association of Georgia, Joseph Donnelly prepared an online video, http://ptagonline.org/legislative, so physical therapists can familiarize themselves with the essential changes found in HB 505. He recommends professionals give Sections 1, 3 and 6 the most attention.

Section 1 gives a revised definition of the practice of physical therapy, which represents contemporary physical therapy practice in the 21st century. This includes the physical therapist’s role in injury reduction, and promotion and maintenance of health, fitness and wellness in populations of all ages. It also helps define the PT’s role as teacher, administrator and researcher.

Section 3 covers how a physical therapist refers to himself or herself. A PT must clearly inform the public of their credential. When a doctor of physical therapy makes an introduction to a patient, he or she can refer to himself or herself as a doctor, but must follow that by saying, “I’m a physical therapist.” These credentials are protected in Section 3, which states that no person or business can use the terms physical therapy, physical therapist, physiotherapist or doctor of physical therapy or any of the associated abbreviations without a licensed practitioner on board.

The rules of self-referral are covered in Section 6. In order to treat a self-referred patient, you must be a doctor of physical therapy with at least two years of experience; a doctor of physical therapy with post graduate certification, ABPTS specialist certification, residency or fellowship training; or have five years of clinical experience. To perform dry needling intervention on a patient that self refers, a PT must be in consultation with a physician. When a patient self refers, the PT is required to provide a written disclosure that a physical therapy diagnosis is not a medical diagnosis by a physician or based on radiological imaging, and that such services may not be covered by the patient’s health insurance plan.

If a patient self refers, a PT can see that individual for a maximum of 21 days or eight visits. This doesn’t apply to those seeking assistance in health promotion, fitness, wellness or maintenance; to patients diagnosed in the previous nine months with a neuromuscular or developmental condition; or to patients diagnosed with a chronic musculoskeletal condition in the previous 90 days.

Donnelly stresses the importance of a portion of Section 6, which covers liability. It states that a physical therapist must ensure that he or she has liability coverage either independently or provided by the entity by which he or she is employed.

Georgia’s physical therapy patients aren’t the only ones getting rehab these days. The same goes for the field itself.

Thanks to the new HB 505 law, which went into effect in July, Georgians now have easier access to a physical therapy provider of their choosing without a referral.

“That’s the biggest topic in Georgia right now,” said Dr. Joseph Donnelly, a clinical associate professor and director of post-professional programs at Mercer University’s College of Health Professions Physical Therapy department.

“The modernization of our practice act allows patient self referral to physical therapists as a point of entry into the healthcare system. In that realm, people with neuromuscular and developmental disabilities have greater access now to our services as well to keep them functioning in our society.”

According to Dr. Herb Silver of Sensible Wellness Physical Therapy in Atlanta, this will be extremely helpful in many ways, including simply reducing the number of visits to various providers.

“The parents of children with chronic conditions were having problems with access,” Dr. Silver explained, “and the new practice act allows children to see a physical therapy provider more easily for nine months without going back to a doctor. For parents with special needs children this has reduced a huge burden.”

Dr. Silver says he also thinks the corporate world will take advantage of the new legislation by getting injured employees immediate care from a physical therapist. This has been a big benefit in other states with direct access to physical therapy.

“Employees get back to work more quickly, they report greater satisfaction with their care and they generally have a better experience with direct access to physical therapy,” said Silver.

Although the practice laws have changed, Silver says they still lag behind the rest of the country. This remains ironic, he explains, due to the high level of educational institutions and researchers specializing in physical therapy in Georgia. Armstrong State University, Emory University, Georgia Regents University, University of Georgia, Georgia State University and the University of North Georgia all have strong physical therapy programs.

As physical therapy access laws have changed, so has the field itself. Although the general public perception of physical therapy may be confined to the clinic, it stretches far beyond those borders.

“When I was [younger], I didn’t know much about what a physical therapist did as a profession,” said Dr. Rhett Roberson, clinic director at the Sports Rehabilitation Center in Atlanta. “I think that’s still largely the case amongst average citizens. And that’s largely a branding problem for physical therapists in general and something we’re continuing to work on.”

It was during his observational hours and college classes that Roberson became aware of what a large spectrum the physical therapy field spans. In the hospital setting alone he found physical therapists treating people immediately after surgery, working with patients in the ICU and treating babies born prematurely. He saw PTs aiding those with developmental disabilities of all types, and administering treatment to those affected by neurological disorders, and traumatic brain and spinal cord injuries.

A variety of cutting edge research continues across the physical therapy landscape. For example, Silver says chronic pain is something physical therapists are literally looking at under the microscope. This research includes examining chronic pain models in mice and how the nervous system is affected by chronic pain.

“The research that PTs are doing now is so complex it’s mind boggling,” he explains. “Physical therapists do research on genetic factors that might lead to someone getting chronic pain after an injury or after surgery,” he explains, “and how you would alter the treatment in order to prevent that from happening. This is miles beyond where physical therapy was even just five years ago.”

Research has shown that some people have a gene that predisposes them to having chronic pain after an injury or surgery. Physical therapists are looking at this gene and identifying people who have this before they have surgery. They’re modifying their rehabilitation programs to prevent people from developing chronic pain.

A less glamorous yet equally important contemporary focus in physical therapy, according to Silver, is fall prevention. For example, while osteoporosis requires treatment, patients who learn fall prevention techniques lessen the likelihood of their condition becoming more serious.

Another nuts-and-bolts attribute to physical therapy, Silver says, can be tied to hospital discharge. If a physical therapist is included in a patient’s hospital discharge evaluation, it can substantially prevent readmission.

“If someone gets readmitted to a hospital because they were discharged too soon, the hospital has to eat that readmission cost,” Silver said. “So it’s a big deal if you can prevent people from being readmitted, and physical therapists are involved in that in some hospitals.”

Physical therapy can also have an effect on something as serious as Parkinson’s disease. Research points to physical therapy as a way to slow down the progression of the disease.

“If a person recently diagnosed with Parkinson’s goes to the right physical therapist,” Silver said, “there’s a chance that their Parkinson’s won’t ever progress with the right kind of intervention and physical therapy.”

Other new frontiers include physical therapists doing research on robotically assisted devices to help people gain better function in their arms and legs after spinal cord injuries. This relatively emerging field finds a computer system integrating with a person’s nervous system.

A new understanding of muscle function, Silver says, also plays a part in current physical therapy practice. The use of biofeedback and ultrasound helps physical therapists understand how to make muscles work that normally wouldn’t.

“The way muscles function and they way they function when there’s an injury is very much misunderstood,” he said. “It isn’t that people get weak, but it’s that muscles don’t turn on in the proper order that they’re supposed to. And understanding the mechanisms that go into that type of function is extremely complicated.”

With the advent of HB 505, coupled with contemporary advancements in the art and science of physical therapy, the future of the field in the state couldn’t be brighter.

“We have an amazing opportunity to demonstrate the value of physical therapy in Georgia,” Donnelly said.