1. Medicare direct access for OT ( I saw that this was discussed
earlier, wanted to see what the reactions were now)

Medicare direct access is not likely to happen in the immediate future
due to intense political pressure against it from physicians and
gatekeepers.  That being said, it remains critical for our profession to
keep our eye on the ball.  Should physical therapists gain direct access
through Medicare, it could have far reaching consequences to
occupational therapy.  If constrained by the 30 day recert requirement
and physician visit, occupational therapy could find itself severely
disadvantaged by direct access to physical therapists.  Coupled with the
expanded scope of practice promulgated by the APTA, our profession would
be greatly hindered should direct access be provided to PT.  I repeat,
While I am relatively sure such legislation could not pass, the current
climate of reducing costs to the federal healthcare system could change
that.  I have introduced a motion to this year's representative assembly
directing AOTA to introduce similar legislation should the PT
legislation be introduced again this year.  While I am extremely
reluctant to follow the typical OT chasing PT history, I believe this
protective step is important.

2. Entry-level doctoral program for OT

All it is is marketing to attract students in an otherwise very
competitive market for enrollment.  I believe it is the wrong direction
for our profession and demeans the efforts and honors granted to those
who seek and earn true doctorates.  I recognize why programs are doing
this and I hope they incorporate educational standards consistent with
the degree.  My biggest concern is with the fallout from BBA97 which
continues to keep our academic programs under-enrolled.  Coupling this
with the move to an entry level masters follewed by the quick descent to
a doctorate may likely cause a double dip in enrollment as fewer
applicants are doctorate prepared. 
 
I know that the physical therapists harbor hopes of gaining
prescriptive authority under the doctorate but frankly I would be
surprised to see that happen.  To be brutally honest, I don't think
either of our current academic curriculums prepare us to be a primary
care provider and I, for one, would not want the responsibility of
diagnosis (not to mention the malpractice insurance) for patient care. 
PT's would argue that Chiropractors have prescriptive authority and it
has promoted their profession greatly.  Personally I can't speak to the
preparation of chiropractors vs physical or occupational therapists to
make diagnoses but would be interested to hear from others who can make
the comparison better than I can.

3. PTs claim on function as well.

I have never been too worked up about this one.  In my facility OT's
and PT's work quite interchangably (hospital acute care)  Each works
from their theoretical roots and I think having the freedom to not break
patients down by body areas or modalities is empowering to our
professions.  If a PT feels working on ADL's will enhance range of
motion, balance, and strength, this is of benefit to the patient.  If an
OT feels increasing strength, range of motion, and balance will increase
independence in self care, these treatments should be incorporated into
the treatment plan.  
Where the potential danger lies is when one profession or the other
attempts to justify their intervention as superceding the need for the
other.  This overly simplifies the role of each profession unfairly. 
Any OT who feels training in self care is the true goal of what we do is
not addressing the true role of OT which is to instill a sense of
accomplishment, independence, and autonomy that can't exist when unable
to meet their personal needs.  I know I'm preaching to the choir on this
one, but I get frustrated when OT's fall into the cookbook role of
quantifying independence as being able to carry out self care.  This is
merely an indicator of the true goal as referenced above.  Personally I
don't believe a PT can address this component of rehabilitation nearly
as effectively as an OT.  But that doesn't mean they can't use self care
and function as a treatment intervention to accomplish their PT goals.

Long windedly yours



Redge L Campbell MS OTR/L
Director of Rehabilitation Services
Harrison Hospital
Bremerton, WA  98310
360.792.6531

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