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Tipping the Scales of Time

JK Richardson, PT, PhD, OCS, is Chairman, Department of Physical Therapy and Occupational Therapy, Duke University Health System, and Professor and Chair, Doctor of Physical Therapy Program, School of Medicine, Duke University, Box 3965, Durham, NC 27710 (USA) (richa052{at}mc.duke.edu)

	Introduction

 
I truly am pleased to see so many of you here today and want to thank you from the bottom of my heart for sharing this special day with me ... being that this is the last Presidential Address of my term as President. However, to see so many people in the audience reminds me of a comment that was once made by Sir Winston Churchill when he was congratulated on the size of the audience that had come to hear him speak. It was no great achievement to draw such a crowd, Churchill said, "Twice as many would have turned out for a public hanging."

While I know that this is not a public hanging, I would like to avail myself of the condemned man's right to say a few last words ... in this case, my thoughts on where the profession of physical therapy must go in the future. I am not here to dwell on our problems. It is no good telling people about your problems anyway, because 90% of the people don't care and the other 10% are glad you have them!

But I am here to remind you about how we in our profession have fared in the past century and what we need to do to survive in this new century. I assure you that the scales of time have measured what we have accomplished in the past and will tell what we can achieve in the future.

	The Past Century

Top Introduction The Past Century The New Millennium Future Strategies Tipping the Scales

 
The past century has been good to us. It brought us the birth of physical therapy as a profession and the development of our Association. In 1921, we were reconstruction aides, treating those injured in World War I. It was projected that with the end of the war, the need for physical therapy would cease and the profession would die. But our founding leaders would not have it so ... and not only did we survive, we flourished! We moved from treating those injured in the war to treating those with congenital diseases, those with disabilities, and the victims of the polio epidemics. And we moved from solely hospital-based practice into other settings.

The 20th century brought us other victories. We saw our educational preparation move into universities, we won independent accreditation, and we worked to see that the postbaccalaureate degree became the entry-level academic requirement.

In practice, we fought to be carved out of unions that other health care professionals were entering, we won reimbursement for our services, and we progressed from being solely generalists to being specialists. We developed advanced clinical competencies and established board certification. We fought to secure direct access in 33 states, allowing us to serve as primary clinical care practitioners to meet the needs of our patients and their families.

We had other victories in the legislative arena as well. We secured licensure and practice acts that defined our scope of practice. We received provider status with federal and state governments and with commercial insurance carriers. We sued the Health Care Financing Administration (HCFA) on behalf of our patients and won. We were sued for performing electrodiagnostic testing and won. We were sued for performing manipulation and won. And as the end of the century neared, we won our battle to remove the limiting cap on reimbursement for our patients... ending 27 years of arbitrary and capricious decision making by the federal government.

Our victories have been many throughout the past century. But what does the new millennium have in store for our profession? What will the new century hold for us?

	The New Millennium

Top Introduction The Past Century The New Millennium Future Strategies Tipping the Scales

 
Imagine yourself in a room with 100 of our first-year graduate physical therapist students. At least 80 of them will live to be more than 100 years of age. That means that some will have lived in 3 centuries by the time they die—the 20th, the 21st, and the 22nd! And these new graduate students, our future colleagues, will have been raised on technology, ranging from television to the Internet.

Imagine this: More products will be sold on the Internet in the next 10 years than were sold in all the stores in America in the entire 20th century! From toys to books, to cars and plane tickets, to houses and groceries that can be delivered to your front door. What will the future hold? In our wildest imagination, we can only begin to guess.

But let's imagine for a moment what it could hold for us in our profession of physical therapy.

Imagine practice without arbitrary limits on reimbursement because we have proven our responsibility and accountability as practitioners. We have this opportunity over the next 2 years. The door has been opened, and we have the chance to act responsibly in our patients' best interests by offering high-quality care, that is medically necessary, in a reasonable and cost-effective manner.

Imagine practice through telecommunications. "Virtual reality care" not just with sight and sound, but with touch and smell. Virtual care that will enable us to provide services to those who have no access to us now ... whether they are in our own country or in other nations. I see us in the future even sending physical therapists into space to treat those who will permanently live and work aboard orbiting hotels and offices.

Imagine extending this technology into education with "actual-time long-distance learning," so that the classroom may be wherever the learner is located. In physical therapy, because of our hands-on care, we will need to find creative and effective methods to apply this technology. We must do so, though, without depersonalizing the learning experience or replacing our personal human interaction with only technology in our efforts to facilitate intellectual learning and professional growth.

Imagine a profession in which all physical therapists hold a doctoral degree. A profession in which the DPT is the sole professional degree designation for those graduating after the year 2020 ... and for those of us who entered before, having the option to obtain the DPT by numerous alternatives in a user-friendly manner, including within the comfort of our own homes, at our own leisure, on our own time schedule.

Imagine a profession that is founded on evidence-based practice versus routine consensus-based practice. Research that is rich in validity and strong in reliability. Research that is the fundamental basis upon which our practice is built. Research that is critically solid in its application but still questioning enough to outgrow itself as time and talent progress. Albert Einstein challenged us "not to stop questioning," inspiring us to remain curious, for "curiosity has its own reasons for existing." If we nurture our curiosity and grow it strong, the fundamental science of our practice will flourish to equal the compassionate art of our healing.

Last, imagine the evolution of our profession to physician status. Physical therapists obtaining the recognition, respect, responsibility, and all the privileges of autonomous practice. Securing direct access under every state law for all people in need of our care. Fifty states united in providing physical therapy care to their citizens for examination, evaluation, diagnosis, prognosis, and intervention without the undue necessity of referral or professional servitude! Care that could include diagnostic testing, diagnostic imaging, pharmaceutical provision, and surgery, while using the finest of skilled maneuvers with our patients, clients, and the health care system. A health care environment in which physical therapists, assisted by physical therapist assistants, are the only preferred providers of care for those with neuromusculoskeletal impairments, functional limitations, and disabilities.

All this is a beautiful picture of what the future may hold. But it is by no means assured. Today many of our members are fearful. Fearful about whether we will all have the necessary degree or credentials. Fearful about whether some physical therapists are practicing as primary care practitioners or treating animals, fearful about the ethics and legality of telehealth. Seventy-nine years ago, we began as aides to physicians. We are now major players in health care. Let's not waste our resources on protecting what we have. Let's grow what we have into more. We need to be assertive, accomplished, and confident.

	Future Strategies

Top Introduction The Past Century The New Millennium Future Strategies Tipping the Scales

 
We must not march into the future afraid. Fear has no place in the future of our profession. Fear of unemployment, fear of competition, fear of our own generation being brighter and bolder than those who came before us. Ours is a future of opportunity. Ours is a future of hope. Ours is a future of achievements, and I have no intention of surrendering our profession's values, obligations, and honor to fear.

We have won many battles this past century, but that does not ensure future victories. We need to elevate our profession, our care, and our patients, and this will be accomplished by the recognition and respect that we will gain from others. Our achievement should be measured by the conflicts we avert, the prosperity we share, and the care we extend to those in need.

This balance between daring and strength on one side and respect and compassion on the other will require time and patience. As a scale may tilt and teeter when presented with a new force, our profession must learn to react to external and internal forces, not with unsteadiness and concern but with the flexibility and adeptness that regains balance and equilibrium. At times, it will require patience on our part. Patience that will evolve out of our confidence in who we are, not out of compromise with those with whom we must negotiate in health care. And it will require time. Time to evolve to the highest level of provider based on the consistent quality of care and standards of practice that we will demand of ourselves.

This year we have created our Vision, "A Vision for 2020." Now, we must set our strategies and priorities to achieve our goal and move forward. Otherwise we will be doomed to drift aimlessly as a leaf in a strong, surging stream: no purpose, no direction, no destination ... simply purposeless movement, reacting only to the crisis of the moment. Instead of becoming reactors, we must set our gaze on our goals for the future and continue steadfastly on our journey to achieve them without being drawn off course by the obstacles strewn before us.

To achieve our Vision will take a united effort by all of us who call ourselves leaders, who call ourselves physical therapists, physical therapist assistants, and students! Remember that leaders do not pale from the future or the unknown. They do not quiver in the shadows or quake at the thought of conflict. They are neither petrified nor paralyzed at the possibility of failure. For failure exists only in one's mind!

This is not what leaders do! True leaders lead! They go where many others never dreamed or dared...and by doing so, they take many others with them—leading the way with hope and strength and daring.

This is what leaders do, and what they are. Leaders live on, not by the number of their followers, but by the number of leaders they have made. New leaders to move the Vision forward even further.

So what do we need to do to be successful in this new century?

• We need to take advantage of our opportunities and turn them into action.
  
• We need to elevate our profession, our quality of care, and our patient advocacy.
  
• We need to earn respect and recognition through our education and practice.
  
• We need to learn to be flexible and adapt in anticipation of change.
  
• We must develop a plan to help us achieve the goals of our Vision so that all in our profession will benefit.
  

And we must lead ... going forward with a steady focus and determined pace.

This is how we will meet the future!

	Tipping the Scales

Top Introduction The Past Century The New Millennium Future Strategies Tipping the Scales

 
We have ended the 20th century well, and I imagine an even more glorious future for us. I believe that the profession of physical therapy will be powerful, influential, and inspiring in the century to come. I believe that we, as leaders, will be catalysts for growth and unpredictable change. The scales of time will tell the tale and measure our legacy. What will it be? Will it be our first century that will tip the scales or this century led by our generation?

Let history tell of us that we were the generation that made the Vision clear, that we had dreams that soared and achievements to envy. Now is the time to tip the scales and prove that we are worthy. Worthy of the title "doctor." Worthy of autonomous status, and worthy of acceptance by society and health care.

We should not shrink from this challenge. We should welcome it. The times will be tough, but tough times never last ... tough people do. What appear to be today's threats and challenges will be tomorrow's successes.

In this new century, let us tip the scales of time with:

"A Vision, which will be the art of seeing beyond what others have seen

Obtained by

a Strategy, which will achieve what others long thought impossible."

That is your challenge, my challenge... our challenge...in the century ahead.

We can—and will—prove worthy of it!

	Footnotes

 
Dr Richardson's Presidential Address was presented at the Opening Ceremonies of PT 2000: The Annual Conference and Exposition of the American Physical Therapy Association; June 14, 2000; Indianapolis, Ind.

This article has been cited by other articles:

				L. J Nosse and L. Sagiv Theory-Based Study of the Basic Values of 565 Physical Therapists Physical Therapy, September 1, 2005; 85(9): 834 - 850. [Abstract] [Full Text] [PDF]

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