Author response.

I thank Domholdt for her commentary and insights into this article. Her contributions in this area and to the profession are notable, and I am most grateful that she has taken the time to comment upon this perspective.

A central thesis of this article is that increasing autonomy for physical therapists does not exist in a social vacuum and that changes in autonomy have anticipated, and some unanticipated, consequences for the profession, the health care system, and society. In fact, I would argue that the relationship of physical therapists to their communities and society define the type and amount of autonomy that physical therapists enjoy and will enjoy in the future. It is also true, I believe, that there is a time for everything. While we may be impatient or frustrated by the changes that do or do not occur, we must be always cognizant of the needs of our communities so that policies are in place to meet the need for necessary physical therapy services for the public we serve. Fundamentally, our autonomy depends on the needs of people who need our services and on our ability, in an unfettered and efficient manner, to meet those needs.

Physical therapists need to recognize that the communities with which we need to interact as our social role changes are diverse and that this diversity exists both between and within us and those communities. I believe many assumptions are made about the meaning of physical therapist autonomy. As Domholdt writes, physicians have their own motives to control physical therapy as an extension of medical practice. Policymakers may be concerned about the cost and efficiency of allowing another provider to have "unsupervised" access to insurance dollars. They also may be dissatisfied with the status quo and be looking for new provider structures to promote efficiencies and improve outcomes. Sociologists may write of us as a "paraprofession" (1) or as demonstrating "responsible professionalism" in the "higher ranks of subordinate health care workers." (2) I believe that some physical therapists today believe that autonomy is primarily a technical matter, whereas many others believe it has significant socioeconomic connotations. Domholdt's contribution to this dialogue is exceptional as she reinforces the need to consider autonomy within the realm of professionalism and articulates the improvements in physical therapist professional status and autonomy over the last several decades. I believe that Domholdt misreads the connection among "functional autonomy," a "paraprofession," and the American Physical Therapy Association's Vision 2020 statement in this article. "Functional autonomy" was used by Freidson to set a standard whereby a health care occupation could be judged to have moved out of a "paraprofession" status. It is clear, as Domholdt eloquently recites, that physical therapists have more "functional autonomy" today than they did in 1970, that physical therapy is a profession and the public is well served by it.

Autonomy for physical therapists is vital for the future. It is vital because of the importance of autonomy to people who are experiencing disablement. Like today, it will be an autonomy defined by its times and social forces. As long as the profession remains secure in its service focus to people who are experiencing disablement, looking to a future of disease and injury prevention and in dialogue with its communities, the future of autonomous, professional physical therapist practice is bright for a very long time to come.

References

(1) Freidson E. Profession of Medicine: A Study of the Sociology of Applied Knowledge. New York, NY: Harper & Row; 1970.

(2) Starr P. The Social Transformation of American Medicine. New York, NY: Basic Books, The Perseus Books Group; 1982.

DOI 10.2522/ptj.20050245.ar