Introduction:

Physical Therapist as
Professional
Week # 1
DPT 9th Semester
Fall 2018
04/17/2024
1
 Physical Therapist as
Professional
As much as we would like to think so, physical
therapy is not yet completely recognized as a
profession. (Catherine Worthingham)

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• Before deciding on a definition
of [physical therapy], physical
therapists must decide whether
they really want to be
professional or just make believe
they are, by paying lip service to
professionalism. (Mary E. Kolb)

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 The Physical Therapist as
Professional
As a profession, we have arrived
• We have defined our scope of practice.
• We have developed a unique body of knowledge.
• We are documenting the effectiveness of our
outcomes.
• We adhere to a code of ethics.
• And we take responsibility for the well-being of
patients and clients.
• True autonomy is the destination. (Ben Massey)
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 WHAT DOES
PROFESSIONAL MEAN
• As Catherine Worthingham observed in 1965,
physical therapy has not always been considered a
profession
• In the 1966 Presidential Address to the American
Physical Therapy Association (APTA) Mary Kolb
described the definition of physical therapy
• she called on physical therapists (PTs) to engage in a
“reappraisal of the role of physical therapy and a
more appropriate definition of the field.”
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 Continue….

• Not until 35 years later could Massey state that

physical therapy had arrived as a profession
• Undoubtedly, most PTs currently in practice believe
that they are professionals and would consider being
called “unprofessional” an insult.
• However, even though most people use the term
professional frequently in everyday conversation, its
meaning may not be altogether clear or may differ
among groups.
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 Continue….

• The concept of profession and professional has

been the subject of vigorous scholarly debate
spanning much of the twentieth century and
continuing today.
• Changes during the last 50 years in the way that
professions are viewed have raised a number of
important questions for professionals, scholars, and
members of society. These questions include the
following:
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 Continue….

• Should an occupation be designated a profession on

the basis of the possession of specific characteristics,
the developmental process by which the profession
as a whole has gained recognition and status by the
public, or the power the profession is able to handle?
• Does being a professional still hold meaning? Have
health care professionals been “professionalized” by
managed care and “deskilled” by bureaucratic
control within organizations?
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 Continue….

• Which is more important—the individual or the

collective dimension of being a professional?
• Should medicine continue to be the paradigm for
what it means to be a profession and a
professional?
• Have professionals fulfilled their implied contract
with society to be accountable(responsible) and
self-regulating?
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 Preliminary Definitions of
Profession and Professional
• The concept of profession is an ancient one that
has roots in Greek and Roman times. The early
origins of the word are reflected in its Latin
precursor profiteor, which means “to profess a
belief.” This root meaning suggests that
professionals have historically been expected to
have a sense of vocation (to calling).
• Society still expects professionals to exhibit
dedication to their work and clients.
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 Definition
A profession is an occupation that is
viewed by society as a profession on
the basis of its characteristics,
development, or power. 04/17/2 11
024
• Professionalism is the
internalized conceptualization
of expected professional
obligations, attributes,
interactions, attitudes, values,
and role behaviors in relation to
individual patients and clients
and society as a whole.
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• Professionalism may be
collective (practiced by the
profession as a whole) or
individual.

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Individual professionalism refers to
the internalized beliefs of an
individual member of a profession
regarding professional obligations,
attributes,
interactions, attitudes, values, and role
behaviors. Individual professionalism
might also be called “professional role
concept.” 04/17/2024 14
 Profession in Sociological Perspective

• According to Ritzer, sociological literature describes

three approaches to understand profession:
I. Structural Approach
II. Processual (or process) Approach
III. Power Approach

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Structural Approach
The structural approach
focuses on the static
characteristics that an
occupation must possess to
be considered a profession.

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024
 Continue….

• the classic definition of a profession includes at

least four: a body of theoretical knowledge, some
degree of professional autonomy, an ethic that the
members enforce, and accountability to society.

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 Processual Approach

• The Process Approach focuses on either the stages and

developmental periods that an occupation must pass
through or activities that its members must perform to
achieve recognition as a profession.
• The social processes or developmental stages
• Central to this perspective is its autonomy and
professional status through social and political actions
• Autonomy is the defining attribute of professions
(Moore and Pavalko)
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 Continue….

• Those occupations with extensive autonomy in

their work are considered “true professions”; those
with less autonomy are either “semiprofessions” or
not professions at all

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 Power Approach

• The Power Approach believe that a profession’s ability to

obtain the political and social power to define its work is its
most important characteristic.

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Negative aspects of power:

1. setting up economic monopolies

2. using political power for self interest
3. accusing on professional autonomy and self-
governance without consideration of the
public welfare

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Characteristics of Professions

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 Knowledge

• Broad, theoretical, generalized,

systematic knowledge
• Unique body of knowledge
• “Formal” knowledge that is
“embodied and applied in and
through the professional”
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 Autonomy in professional decisions

• Autonomy from client

• Autonomy from organizations or
external parties
• Autonomy in selecting colleagues

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 Authority

• Based on internal knowledge

• Granted by society
• Demonstrated by power and
status in society
• Demonstrated by monetary and
symbolic awards
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 Education

• Extensive
• Skilled, technical, esoteric (Relating to
or being a small group with
specialized knowledge or interests)
• High standards for admission

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 Responsibility, Accountability, and
Ethics

• Service orientation
• Accountability and responsibility to society
• Formal code of ethics that members enforce
• Self-control of behavior through internalized
professional ethic
• Belief in self-regulation
• Community interest more important than self-interest
• Fiduciary(ethical) relationship and trustworthiness
central 04/17/2024 27
 Nature of work and decisions

• Important or essential to clients

• Complex
• Not routine
• Not programmed

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 Role and Identity

• Internally based on a sense of calling

• Formed and driven by the
professional group
• Extending beyond the specific work
situation

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Pavalko’s Continuum

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 AUTONOMY, SELF-REGULATION OF
ETHICAL STANDARDS, AND
ACCOUNTABILITY
Whether a profession is defined by its characteristics, stages
of evolution, or power, the following qualities of
professions have historically been held in high regard:
i. Autonomy
ii. Ethical standards
iii. Accountability

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 Autonomy
• Autonomy is “litmus test” for professions
• Extent to which[a profession] or an individual feel freedom and
independence in the role
• Freedom from clients and the organization that employs the
professional
• Occupations whose members have had high autonomy in decision
making and high degrees of control over their work have been
considered true professions.
• Occupations whose members enjoyed less autonomy in decision
making and less control over their work were relegated to being
semiprofessions, paraprofessions, or nonprofessions. 04/17/2024 32
• Many medical professionals perceived this loss of autonomy
as a loss of professional status, or “DE professionalization,”
because they were no longer able to freely make decisions
based on their expertise and specialized training.
• Until recently, the tendency has been to view physical
therapy as an occupation in the process of
professionalization but not yet fully recognized as a
profession.
• However, many PTs have experienced significant increases
in their autonomy over the last 20 years
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• One measure of professional autonomy is access
to PTs without physician referral.
• In 1985, only 7 states allowed direct access of
patients to PTs. By 2002, 35 states permitted
direct access and 48 states allowed PTs to
perform initial evaluations without referrals.

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• The APTA has established the goal of “autonomous
practice”,in its Vision 2020 statement:
• “Physical therapists will be practitioners of choice in
clients’ health networks and will hold all privileges of
autonomous practice.”
• but few PTs have privileges to refer patients directly for
diagnostic tests. At the same time, managed care and other
third-party payers have imposed restrictions on most
health care services, including physical therapy
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 Autonomy (cont..)
• Whether PTs have enough autonomy in their work
to be considered professionals??
• For much of physical therapy’s history, PTs have
worked under the supervision of or through referral
from physicians.
• “Physical therapists will be practitioners of choice in
clients’ health networks and will hold all privileges
of autonomous practice.” (APTA VISION 2020)
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 APTA BOARD OF DIRECTORS’
POSITION ON AUTONOMOUS
PHYSICAL THERAPIST PRACTICE
• It is the position of the APTA Board of
Directors that:
• Autonomous physical therapist practice is
characterized by independent, self-determined
professional judgment and action. Physical therapists
have the capability, ability and responsibility to
exercise professional judgment within their scope of
practice and to professionally act on that judgment.
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 Privileges of Autonomous
Practice in 2020
• Each of these elements includes two overarching
concepts: recognition of and respect for physical
therapists as the practitioners of choice, and
recognition of and respect for the education,
experience, and expertise of physical therapists in
their professional scope of practice

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 Autonomy Physical therapist gets as a result of DPT
1 Direct and unrestricted access: The physical therapist has the professional
capability and ability to provide to all individuals the physical therapy services
they choose without legal, regulatory, or payer restrictions.

2. Professional ability to refer to other health care providers: The physical

therapist has the professional capability and ability to refer to others in the
health care system for identified or possible medical needs beyond the scope of
physical therapist practice.

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• Professional ability to refer to other professionals: The physical
therapist has the professional capability and ability to refer to
other professionals for identified patient/client needs beyond
the score of physical therapist practice.

• 4. Professional ability to refer for diagnostic tests: The physical

therapist has the professional capability and ability to refer for
diagnostic tests that would clarify the patient/client situation
and enhance the provision of physical therapy services.
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• It’s not really autonomy that we as a profession seek. . . . We
seek unfettered practice that allows us to use our skills,
knowledge, and compassion to our maximum potential. On
behalf of patients and clients, we seek unfettered access to our
services, free from unnecessarily restrictive laws and
reimbursement policies.
• In Rothstein’s opinion, “interdependence is not a sign of
weakness.
• Interdependence is a badge that civilized people wear to
reaffirm their humanity, their capacity for kindness—and
their competence.”
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• in today’s health care environment, no one is truly
autonomous—nor should anyone want to be
autonomous when we consider the meaning of the
word. . . . “Autonomy” conveys arrogance.
• Regardless of the academic degree PTs hold and
limits of the law, these skills likely will remain the
key to autonomous practice and its concomitant
independent, self-determined judgment and action.

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