Guest guest Posted February 13, 2011 Report Share Posted February 13, 2011 All, I attended a superb panel discussion at CSM in N.O. last week regarding Licensing, Competencies, and Professional Development. Kudos to the presenters. There was significant discussion regarding whether A) Licensing, Comp, and Prof Dev are (or should be) interdependent, state requirements for Continuing Ed sufficiently improve public safety, and C) how the new CEU-requirement for license renewal can be of relevance to each practitioner in their specialized setting or niche. A) & need not be a difficult issues. Simply think of the motor vehicle licensing process and associated responsibilities as a guide for PT practice. Driver's licenses do not ensure you won't speed or stop at a red light. This isn't the purpose. It's merely a statement to the public that you have baseline skills and sufficient operation. Same with the National PT Licensing Exam. You can pass with 100% and still be (even unwittingly) unethical, unsafe, and unscrupulous. Intentional and unintentional rule breakers have a greater chance of fines, license revocation, personal/property injury. Our quality lessens and liability increases when our skills and compliance fade. In driving and in PT practice. To preserve skills and improve knowledge and technique, driving schools exist and insurances often offer a safe driver discount. Similarly, required CEUs for PT license renewal provides a mechanism for the therapists to stay engaged with professional content and self-police their skills and abilities. Better drivers hit less curbs. Additionally, we need to beef up infractions against practitioners who fail to report egregious rule breakers. In the military, if a person repeatedly messes up, it is often that the person and their superior are both in trouble. The person for doing it and the superior for allowing it to happen. In driving and in PT practice, the police have a way of finding the outliers. For C), I recommend the APTA support a position that license holders should have required CEU content that is focused on their designated primary practice population or setting. This would be in addition to general training on ethics, law, reimbursement, etc. Same with those in management and academia. We should be compel ourselves to have documented competencies equivalent to the persons we supervise and teach. Respectfully intended, Alan Petrazzi, MPT, MPMRehab DirectorMurrysville, PA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2011 Report Share Posted February 15, 2011 Hi Alan, Great post on licensing, competency and professional development from CSM New Orleans. Thank you for putting this important discussion on the list-serve. I would like to offer a counter-point to licensing as a means to improving public safety: Milton Friedman once demonstrated that the actual function (not the stated function) of medical licensing was to reduce the supply of license holders and increase the price of the services we offer. Lawrence Weed, MD demonstrated that medicine has been defined as those things which are done by people who hold medical licenses. That is, medicine is defined as a core of knowledge rather than a core of behaviors. If you examine state practice acts, you'll find licenses are presented as a means of protecting public safety while unlicensed medical activity is considered dangerous and unlawful. 500 Americans die, however, per day as a result of the actions of license holders. The traditional approach to public safety has been training, specialization, residencies and clinical internships to pass to students the required knowledge to treat patients according to the standard of care. A core of knowledge requires continued competency at memorizing, remembering, retrieving and processing medical information relevant to the patient at the point-of-service. A computer mind is better than a human mind at these functions. A core of behavior requires the license holder follow certain evidence-based processes within a structure that is appropriate for that patient's condition (eg: home care for non-ambulatory, community dwelling adults). Mistakes in medicine are seldom the result of unscrupulous, ignorant or negligent physical therapists and physicians. Instead, mistakes are the result of system-wide errors in handoffs, improper follow-up, improper treatments and improper financial incentives. Safety is better addressed by improving the system than by improving the clinician. More rules, penalties and policing directed at the clinician seem to just uphold the status quo. " Naming, Blaming and Shaming " as a part of the medical culture is not going to improve patient safety - its just going to increase the defensive medical practices that today cost many billions of dollars and lead to a cult of secrecy in medicine and physical therapy. The future of healthcare is inextricably tied to transparent computerization such as Electronic Medical Records with Clinical Decision Support. Transparent computerization will lead to a decline in the value of healthcare providers whose skills are derived from a core of knowledge. Instead, decision support technology will reward providers whose skills derive from a core of behaviors. Behaviors are processes that will be determined by the setting and the structure we work in. Clinical practice guidelines define best practices for many settings like acute post-surgical care and conditions like lower back pain, urinary incontinence and post-stroke rehab. Decision support technology can actually measure the day-to-day adherence of the physical therapist to evidence-based practice guidelines at the level of the clinician, the clinic, the health systems or the region. These measures, to me, seem to be better metrics to assess continued competency and ongoing suitability for physical therapist licensure than continuing credit hours or knowledge-based classes. For example, a physical therapist with 20 years' experience would still need to show 80% adherence to certain, current evidence-based guidelines for the caseload they see in order to be eligible for re-licensure. Exceptions for administrative or teaching physical therapists would have to be determined. Thank you for bringing this subject up - I would be interested in what the group thinks about the initiative from FSBPT to require re-testing as a condition of re-licensure? Will passing a written exam make my patients more safe? Thank you, Tim , PT www.PhysicalTherapyDiagnosis.com > > All, > I attended a superb panel discussion at CSM in N.O. last week regarding Licensing, Competencies, and Professional Development. Kudos to the presenters. > There was significant discussion regarding whether A) Licensing, Comp, and Prof Dev are (or should be) interdependent, state requirements for Continuing Ed sufficiently improve public safety, and C) how the new CEU-requirement for license renewal can be of relevance to each practitioner in their specialized setting or > niche. > A) & need not be a difficult issues. Simply think of the motor vehicle licensing process and associated responsibilities as a guide for PT practice. > Driver's licenses do not ensure you won't speed or stop at a red light. This isn't the purpose. It's merely a statement to the public that you have baseline skills and sufficient operation. Same with the National PT Licensing Exam. You can pass with 100% and still be (even unwittingly) unethical, unsafe, and unscrupulous. > Intentional and unintentional rule breakers have a greater chance of fines, license revocation, personal/property injury. Our quality lessens and liability increases when our skills and compliance fade. In driving and in PT practice. > To preserve skills and improve knowledge and technique, driving schools exist and insurances often offer a safe driver discount. Similarly, required CEUs for PT license renewal provides a mechanism for the therapists to stay engaged with professional content and self-police their skills and abilities. Better drivers hit less curbs. > Additionally, we need to beef up infractions against practitioners who fail to report egregious rule breakers. In the military, if a person repeatedly messes up, it is often that the person and their superior are both in trouble. The person for doing it and the superior for allowing it to happen. > In driving and in PT practice, the police have a way of finding the outliers. > For C), I recommend the APTA support a position that license holders should have required CEU content that is focused on their designated primary practice population or setting. This would be in addition to general training on ethics, law, reimbursement, etc. Same with those in management and academia. We should be compel ourselves to have documented competencies equivalent to the persons we supervise and teach. > Respectfully intended, > Alan Petrazzi, MPT, MPMRehab DirectorMurrysville, PA > > > > > > Quote Link to comment Share on other sites More sharing options...
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