Making Vision 2020 a reality.

Three years ago, the APTA House of Delegates adopted Vision 2020. It is a bold but tangible vision of where the profession of physical therapy sees itself in just 17 years. Our shared vision has united our members, focused our attention on the really important issues, and distinguished our profession among our health care colleagues.

Three years ago, the House of Delegates elected me to serve as your President. To serve this profession that all of us love so dearly has been a great honor and a privilege. And to serve as President for the initial years of our quest for Vision 2020 has been an awesome experience for me. During the past 3 years, the House has consistently elected officers and members of the Board of Directors who have brought their talents, tireless commitment, and mature wisdom to lead this Association, to carry out the mandates of our members--to make Vision 2020 a reality. And we have required all their talents for this monumental task.

At a retreat in the fall of 2000, your Board of Directors determined that if we are to achieve our Vision--a vision of becoming an autonomous profession--we must focus our efforts on 5 key areas:

1. Professionalism,

2. Direct Access,

3. The Doctor of Physical Therapy,

4. Evidence-Based Practice, and

5. Practitioner of Choice.

I'd like to take a few minutes to trace our progress and to share with you my assessment of some of the work yet to be done.

[Massey BF Jr. 2003 APTA Presidential Address: Making Vision 2020 a reality. Phys Ther. 2003;83:1023-1026.]

1. Professionalism: At a recent regional caucus of delegates, a vote was taken as to which of the 5 components of the Vision they felt was the key to achieving tour Vision. The vote was unanimous--professionalism. The same professionalism that our professors and instructors tried to instill in us from the first days of our professional education. The quality that makes us want to learn everything we can so that we can provide the best care to our patients. The quality that makes us stay late or come in early so that we can see a patient in pain. The quality that makes us intolerant of unethical behavior. The quality that makes us willing to get involved in politics and advocacy. Professionalism captures the essence of our Vision.

Are we more professional than we were 3 years ago as a result of our efforts toward Vision 2020? I don't know. How do you measure professionalism? Are we more focused on the outcomes of our patients? Have we begun to internalize a greater sense of responsibility for our patients? My communication with members around the country suggests to me that we have. I am certain that we have become stronger advocates and more politically active.

2. Direct Access: With the addition of Virginia, Pennsylvania, New Jersey, Wyoming, and Louisiana over the past 3 years, 38 states now have some form of direct access--and direct access legislation is still pending in several others. In addition, several states have improved their practice acts to allow less-restricted access.

Nationally, Medicare direct access has been at the top of our priority list. Who would have dreamed in June 2000 that by today we would have introduced our second direct access bill; that we would have 78 sponsors in the House of Representatives and 8 sponsors in the Senate; that we would have more than 2,000 physical therapists, physical therapist assistants, and students inarching on Capitol Hill tomorrow; that members of our Association would have donated more than $1.2 million dollars to the PT-PAC, so that we would be ranked third among nonphysician health care PACs in the country; and that we would have the support and endorsements of national consumer organizations. Direct access is no longer just a dream. It is becoming a reality!

3. The Doctor of Physical Therapy: I believe the Doctor of Physical Therapy (DPT) degree has now been embraced by the majority of our members. In the past 3 years we have grown from 19 professional [entry-level] DPT programs to 74 programs. Within 5 years we expect to be at 150. In the past 3 years, 35 transitional DPT programs have developed, and several thousands of physical therapists are enrolling in these programs.

4. Evidence-Based Practice: Evidence-based practice has been incorporated into all accredited physical therapist education programs. Our graduates are learning the value of research and evidence. Hooked on Evidence, APTA's new online database, has had phenomenal growth, with more than 800 articles currently available to help us incorporate evidence into the art and science of our practice.

5. Practitioner of Choice: Increasing awareness among consumers about physical therapy is an important part of the Vision 2020 process. We have taken many solid steps over the years, and most recently we have enhanced our efforts by providing members with more than 400,000 free copies of the PT Magazine consumer supplement each October and by developing exciting plans to enhance the consumer focus on our Web site. These are worthy and important efforts, but I believe the achievement of recognition as practitioners of choice must be based on the quality of our services and our patients' outcomes. If we achieve the other 4 elements of our Vision to their fullest extent, then recognition as practitioners of choice will soon follow.

As your President, I have 3 major goals related to Vision 2020 that I would like to see accomplished during the next 3 years. Number 1 without question, is getting direct access under Medicare. Number 2 is increasing our membership (a vision for the profession of physical therapy must be a vision for all physical therapists and physical therapist assistants). And number 3, I want to see more physical therapists assuming positions of leadership and acting as advocates in local, state, and national arenas.

I believe that we can achieve some form of Medicare direct access in the next 3 years. I believe that when our members put their hearts and souls into an initiative, and that initiative is based on what is in the best interests of our patients, we can make it happen. We--everyone in this room--must make it a high priority. We will achieve direct access in Congress the old-fashioned way--we're going to earn it, one member of Congress at a time.

Why is Medicare direct access the number 1 priority for our future? There are many reasons. The first, and always foremost, is that patients need access to our services and should not be burdened with the requirement of a physician prescription. The second is long overdue professional autonomy. Not professional isolation, but professional autonomy that allows us to become active collaborators with other health care professionals. Professional autonomy that recognizes the full extent of our contributions as members of the health care team. And, as a practical measure, Medicare direct access is critical because of the influence that the Medicare system has on other insurance programs. Direct access also promotes the patient's right to choose a physical therapist, rather than the patient being directed to a physical therapist of the physician's choice, an arrangement that frequently allows the physician to benefit financially from provision of the physical therapist's services. Because many provisions of the Stark legislation have been watered down through regulation, recently we have been seeing an increase in physician-owned practices. Vision 2020 does not envision physical therapists as employees of physicians.

Tomorrow--Thursday, June 19, 2003--each of us has a unique opportunity to be an active and influential participant in the democratic process. In the morning, we will gather for a rally on Capitol Hill. The more of us who attend, the louder will be our collective voice and, consequently, the stronger our message. We will rally in support of the Medicare Patient Access to Physical Therapists Act. We have strong support from Congress, but we need even more legislators behind it to make it a law.

Tomorrow afternoon, more than 900 physical therapists and physical therapist assistants will flood the halls of Congress to visit our members of Congress. Legislators will hear your stories of patients who need our services; they will benefit from your expert opinions on health care matters; and they will see your dedication to and passion for your patients and your profession.

Hill visits, and training for these visits, are a routine part of APTA's Federal Government Affairs Forum every spring. I am so excited to bring this opportunity to our Annual Conference. I hope that many of you who might never have tried advocacy in the political arena will step forward and take a chance. And even if you haven't signed up for Hill visits, I hope that you will join us tomorrow morning for the rally. Standing together with your colleagues on Capitol Hill is a once-in-a-lifetime opportunity. I know that we will make a difference for our profession, and I guarantee that you will leave Washington inspired by your participation in that process.

The second major goal that I would like to see us address in the next 3 years is to increase membership in our Association. A CEO of a major marketing company once told me that the most critical measuring stick of the success of an organization is its membership. In 1997, we had close to 75,000 members--and times were great. Then the Balanced Budget Act of 1997 hit. Most health care associations experienced a significant decrease in membership. Our numbers dropped to a low of 61,092 in 2002. Enrollment in our schools decreased, and student membership dropped by nearly 34%. In response to these declines, we have worked hard to publicize the value of membership in many different ways and, with direction from the House of Delegates, have offered various promotions and incentive programs. But our real problem is not recruitment, it's retention. Members join, stay for a few years, then leave--for a variety of reasons. Currently, our membership is 63,166. This past year we saw physical therapist membership increase 1.02%. In the next 3 years, I want to see our physical therapist membership grow by 10% [4,680 members].

Increasing membership requires a joint effort at national, state, district, local, and individual levels. The Board recently appointed a Membership Task Force, and the first meeting is scheduled for July. For the past 3 years, staff have been working with several states that have struggled with membership, and we have had some success. But you, as individual members, can be more effective recruiting members one-on-one. Three years ago I promised to make communication one of the 3 "C's" of my term as President. I have had e-mail, voice, and face-to-face communication with thousands of members and nonmembers these past 3 years. What they want most is to be heard. Now I challenge you to make every interaction with a nonmember an interaction that inspires the nonmember to become part of who we are--part of the American Physical Therapy Association.

My third goal is to increase our sphere of influence by networking with and becoming involved in other organizations. We must be community leaders and advocates for our patients. Professional activism is a key component of professionalism. We must all be advocates for our profession in our own innovative, courageous, passionate way. We need physical therapists--our patients need physical therapists--to be involved in policy decisions and to be decision makers. When I look at the boards of trustees of organizations such as the United Way and the American Heart Association, when I look at the National Institutes of Health panels, I hope to see physical therapists in decision-making positions. When I look at the lists of officials elected to our state legislatures, county commissions, and city councils, I see other professionals, but rarely do I see physical therapists.

We have some very notable exceptions of whom we are most proud. Commander Penny Royal, US Public Health Service, a physical therapist, is acting Executive Director of the President's Council on Physical Fitness. Jack Close of Nevada, Rebecca Cohn of California, and Greg Wynn of Arkansas have served as state legislators. Beth Coulson is currently serving as a member of the Illinois General Assembly. My good friend from North Carolina, Randy Stewart, is serving as county commissioner. Patrice Winter is a member of the Fairfax, Va, city council. Unfortunately, these are rare exceptions, and we need them to be a more common occurrence. And we, as a profession, need to support our colleagues across the country who seek appointments or election to office. Whenever a physical therapist gets a key appointment or is elected to a local or state office, it elevates the entire profession of physical therapy, and our patients are better served because of the unique perspective that physical therapists bring to these arenas.

We need a physical therapy culture that cultivates and promotes activism. Thomas Jefferson said:

   We do not have a government by the majority, we have a
   government by the majority who get involved.

And Abraham Lincoln said:

   Those who choose not to participate in government are
   doomed to be controlled by those who do.

Not only is it our right as members of a free society to become involved in the social and political process, but, I would argue, it is our responsibility and a vital part of professionalism. Our responsibility as true professionals is to become advocates for our patients. My expectation this week is that many first-time activists will emerge in our profession. The more of us who become involved, the more we Call accomplish. It's that simple.

In closing, I stand before you today full of optimism. I am optimistic that we will see the 5 elements of our Vision 2020 become a reality and that we will be recognized as a doctoring profession. I am optimistic that our membership numbers will grow because our colleagues will see our accomplishments and realize their value to them as individuals and to the future of the profession. Lastly and most importantly, I am optimistic because our Association is made up of members and staff who are the most committed, the most dedicated, the most talented, and the most passionate professionals in the world. We make a difference in people's lives--and we do it for the right reasons.

BF Massey Jr, PT, MA, is Executive Director, North Carolina Board of Physical Therapy Examiners, 18 West Colony Place, Ste 140, Durham, NC 27705-5582 ([e-mail]).

Mr Massey's Presidential Address was presented at the Opening Plenary of PT 2003: The Annual Conference and Exposition of the American Physical Therapy Association; June 18, 2003; Washington, DC.