Wednesday, February 6, 2008

Irecieved a well written response to my post about NATA's attack on the APTA. In fact, it think the author deserves his response to be brought to our attention and not hidden away in the comments section. I present it here with out comments to allow for you to make you opinions. However, I will post a follow up response to some of his posts, separately.

I commend you for doing your homework before commenting on the educational qualifications of the ATC. Unlike the vast majority of physical therapists who oppose athletic trainers on almost all issues with little to no knowledge of the profession, educational preparation, qualifications and clinical proficiencies of the ATC, you have actually taken the time to investigate the profession and become educated.

I have to state that I disagree completely with your argument that ATC are unqualified to provide manual therapy to orthopedic patients. I also disagree that ATC are not trained in systems review.

While this may have been true a decade or more ago, the curriculums of athletic training programs have greatly expanded to include differential diagnosis and system review courses that do not involve the evaluation or treatment of orthopedic or sports injuries.

While I acknowledge that the program you selected appears to lack a manual therapy course, I would offer that, without course syllabi, we really have no idea of the didactic content of many of these courses. Instruction in manual therapy techniques is a requirement for accreditation for athletic training. The same can be said for an assessment course that includes a systems review of non-orthopedic conditions (in the case of Seton Hall this course is most likely titled General Medical Conditions).

Therefore, although it is not apparent from reviewing course titles, I assure you that students at Seton Hall and all other accredited Athletic Training Programs are receiving education in each of these content areas.

Finally, as a professor who holds each of these credentials and teaches both entry-level athletic training and entry-level physical therapy students, I can honestly state that in terms of their ability to perform an evaluation and differential diagnosis of both orthopedic and non-orthopedic dysfunction, I see absolutely no difference in abilities between graduates from the two programs in which I teach.

Furthermore, given the choice to be evaluated and treated for an orthopedic condition by either group of graduates, I would, without a second thought, select the entry-level athletic training professional. The depth of their knowledge regarding the evaluation, differential diagnosis, treatment and rehabilitation of orthopedic conditions is far superior to that of most physical therapists.

Additionally, students in the entry-level athletic training program receive a far more extensive education in terms of therapeutic exercise, therapeutic modality selection and application, orthopedic assessment (including a full course of evaluation and treatment of the spine) and diagnostic imaging than the PT students at the same institution.

To be fair, the breadth of knowledge that the PT students possess in terms of non-orthopedic conditions (neurological, cardiopulmonary, integumentary, etc.) is far superior to that of the entry-level athletic training students.

This is only one example from one University in the country, but I think it illustrates the need to allow each profession to practice according to their educational competencies and professional qualifications and not according to title alone.

While I wholeheartedly agree that physical therapy should be provided only by licensed physical therapists (not ATC, DC, OT or MD), I would remind you that joint mobilization is a treatment technique provided by a wide variety of qualified practitioners. Joint mobilization is not physical therapy.

I applaud you for taking the time to become more educated on the matter. I wish more physical therapists would follow your lead. However, I would caution you that until you walk in each professional's shoes (as a student and/or an educator), you should reserve judgment on exactly who is qualified to deliver various treatment interventions.

James Scifers, DScPT, PT, SCS, LAT, ATC

Here is my response to these comments


Armin Loges, PT said...

Considering I admit to know next to nothing about ATCs, but having read the official papers/letters regarding the law suit, and reading Dr. Scifer's post, I must comment that if ATCs were so well trained in evaluation and manual therapy it should not bother NATA the fact that we (via our association) choose not to teach techniques we use. Must we be blamed for it?

Anonymous said...

It is not the fact about the teaching on the manual therapy class, I am an AT, and I learned my manual techniques from a DO and I could have taught the class, but it is the discouragement of the profession that is the problem. After all, why do some PT's attend AT seminars.

Anonymous said...

FALSE STATEMENT on the NATA website.

"While practice act oversight varies by state, athletic trainers practice under state statutes recognizing them as health care
professionals similar to physical therapists, occupational therapists and other health care professionals. Athletic training
licensure/regulation exists in 46 states, with aggressive efforts underway to pursue licensure in the remaining states and
to update outdated licensure. Athletic trainers practice under the direction of physicians"


"The AMA states that the term “provider,” as found in the Physical Medicine section of the CPT code, is a general term
used to define the individual performing the service described by the code. According to the AMA, the term “therapist”
is not intended to denote any specific practice of specialty field. Physical therapists and/or any other type of therapists
are not exclusive providers of general physical medicine examinations, evaluations and interventions. Similar to the
athletic training evaluation and re-evaluation codes, other therapists have their own specific evaluation codes."


On November 15, 2004, the Secretary issued a final rule entitled 42 CFR Parts
403, 405, 410, et. al. Medicare Program: Revisions to Payment Policies Under the

Physician Fee Schedule for Calendar Year 2005; Final Rule (the “Final Rule”). 69
Fed. Reg. 66,235 (Nov. 15, 2004). Among other revisions, the Final Rule modifiedthose portions of the Medicare regulations pertaining to therapy services which are included under the “incident to” coverage of Medicare Part B. Id. The relevantCase 3:05-cv-01098 Document 60 Filed 07/21/2005 Page 4 of 27

- 5 -

provisions of the Final Rule at issue authorize payment for occupational therapy and
physical therapy services which are provided “incident to” a physician’s professional
services only if therapy services are provided by an occupational or physical therapist
who meets the qualifications provided by 42 C.F.R. § 484.4. Id. at 66,421-66,422
(revising 42 C.F.R. §§ 410.26(c)(2), 410.59(a)(3)(iii), 410.60(a)(3)(iii)) (the “New
Rules”). The New Rules provide:
§ 410.26 Services and supplies incident to a physician’s
professional services: Conditions.

* * *

(c) Limitations

* * *

(2) Physical therapy, occupational therapy and speechlanguage

pathology services provided incident to a

physician’s professional services are subject to the

provisions established in § 410.59(a)(3)(iii),

§ 410.60(a)(3)(iii), and § 410.62(a)(3)(iii).


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