We have arrived! (2001 APTA Presidential Address).

When I ran for election a little more than a year ago, I did so with pride and passion and a profound commitment to this profession and our Association. I was prepared for the work that would be required of the job, but I was not as prepared for what I would experience in return. I've had the privilege of meeting hundreds of you this past year. And your pride, and your passion, and your commitment have inspired me.

I am so proud to be a member of a profession that transforms and restores people's lives. And I am equally proud to be part of an association membership who stands up for the public we serve--and who goes after what we believe in.

The images you just viewed [in APTA's new video "We Live for Moments Like These"] are extraordinary. And what is perhaps equally extraordinary is that these are the images of everyday physical therapy--from making it possible for a grandmother with debilitating arthritis pain to hold her grandchild to enabling a prima ballerina who has been injured to return to the stage. Yes, any one of you could have been featured in this video for the extraordinary things that you do every single day, that you do with skill and expertise and a unique body of knowledge backed by scientific proof, that you do with heart, and soul, and passion.

[Massey BF Jr. 2001 APTA Presidential Address: We have arrived! Phys Ther. 2001;81:1830-1833.]

Physical Therapy: The Science of Healing. The Art of Caring.

That is the slogan you read at the end of the video. It is the theme for this year's National Physical Therapy Month. And it is so eloquent in its description of what we do that we will give this phrase a permanent home, carrying it on all of APTA's materials from now on. One unified message. As a profession, we are ready.

Consider what we've accomplished in recent years. The Guide to Physical Therapist Practice (1) represents years of work by hundreds of members. This incredible document defines the depth, breadth, and scope of physical therapy practice like nothing else in our history, and thousands of us now live by it in our practices every day. A Normative Model of Physical Therapist Professional Education (2) and A Normative Model of Physical Therapist Assistant Education (3) are landmark documents that are based on consensus in defining the content of physical therapy education. And the new Clinical Research Agenda (4) charts a clear course for us in the area of physical therapy research.

It is because we have become unified in our description of physical therapy practice, education, and research that we have been able to embrace a clear course for our profession's future. APTA's Vision Statement 2020 looks to a future bright with possibility, with fully autonomous practice provided by doctors of physical therapy.

According to the Vision Statement: "By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health."

Practitioners of choice--this is a goal upon which we can all agree.

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. We are almost there. The professional doctorate is a crucial element in that journey.

Although we agree on the goal of autonomy, I know that we may not all agree on the need for the DPT. I do understand the apprehension that some feel. But I also believe that today's practice environment demands a doctoral level of education for the new graduate. And many of today's clinicians with bachelor's and master's degrees have moved to this advanced level through experience and professional development.

The DPT is not a requirement for practice in the future. But I ask that you do not rule it out. The DPT is within your reach.

APTA and the education community are dedicated to developing transition DPT programs that take into account your knowledge and your experience. Because of this commitment, our vision for the year 2020 is absolutely attainable.

Reinventing Ourselves

There have been many times in our profession's history when we have had to act with foresight and courage--many times when we've had to "hang in there," reinvent ourselves, and expand our services to new markets.

I don't think anyone would argue that the late 1990s marked yet another of those turning points. The Balanced Budget Act of 1997, which called for a $115 billion cut from the Medicare program, set us back on our heels and harmed many of our patients. I know that there are many of you here this morning who can share stories of lost jobs and cutbacks in hours and salaries. And, even worse, stories of our most fragile patients going without necessary rehabilitation. Things didn't look good for our profession just a couple of years ago. But, true to our roots, we persevered.

We--both as individuals and collectively as an Association--did this in two very important ways. We fought for what we believe in--righting many of the injustices of the Balanced Budget Act, while at the same time directing our energy toward expanding our services to new markets. We developed niche practices in women's health, occupational health, urgent care, and performance enhancement. We are creating exciting, innovative, and critically needed programs in health promotion, fitness, and prevention. I am particularly excited to see many of you developing programs for populations that have long been overlooked when it comes to health and fitness--children with disabilities and chronic illness, pregnant and postpartum women, people who use wheelchairs, clients with arthritis, and the elderly who are at risk for osteoporosis and falls.

Stories From the Trenches

These are exciting times for our profession. Not just in terms of the many new opportunities that we are tapping, but because of what we have accomplished in our traditional settings as well. Those of you in skilled nursing facilities and home health were hit the hardest by the Balanced Budget Act. Sadly, it is patients in these settings who often are most in need and at risk. We went to battle on their behalf. We stormed the halls of Congress with real stories from the trenches, stories of elderly patients trying to recover from strokes, heart attacks, fractured hips--without physical therapy. Because of our collective voice, lawmakers were forced to ask, "How were these patients expected to regain strength and function, to get up and walk again, to become independent, to enjoy life?"

The answer came swiftly and forcefully with passage a year ago of the Balanced Budget Refinement Act, which restored $12 billion in cuts previously made in Medicare payments. And just this' past year, we convinced the Health Care Financing Administration [now known as CMS--or the Centers for Medicare and Medicaid Services] to make adjustments under the Medicare physician fee schedule, increasing reimbursement to physical therapists in 2001 by an estimated $11.5 million. We also persuaded CMS to approve coverage for biofeedback and electrical stimulation for patients who have urinary incontinence, and to recognize the use of electrical stimulation in wound care.

These victories are astounding! As I look back at these events, that familiar line from the movie Field of Dreams comes to mind. Our version goes something like this: "If you have a high-quality service that only you are educated to provide, and if you can document its effectiveness, and if you can show that it saves money in the long run--they will come." And furthermore, if you try to take away this needed service, eventually they will come back!

And what a "comeback" it has been! As more and more patients are gaining--and regaining--access to physical therapy, our ongoing efforts on their behalf are unrelenting.

A Force to be Reckoned With

Among our current priorities is passage of a patients' bill of rights that includes a point-of-service option, greater access to specialists, elimination of gag rules, and accountability of health plans.

We are working to obtain direct access to physical therapist services in the 16 states in which consumers still do not have this right. And we've intensified efforts to receive Medicare payment for direct access. We plan to introduce legislation into Congress for direct access under Medicare. Now that is a big deal!

We've known for some time that HCFA--or CMS--is in desperate need of rehabilitation. The need to reduce regulatory burdens and simplify paperwork is a major concern to physical therapists. We're working hard to make sure that CMS's sometimes arbitrary regulations and policies are eliminated, revised, or clarified.

And APTA is in the courts. We recently filed to become a defendant in a lawsuit brought by the American Chiropractic Association against the Secretary of Health and Human Services (HHS). The chiropractors have asked the court to compel HHS to issue regulations that would prohibit physical therapists from providing manual manipulation of the spine under Medicare. We're not going to let that happen!

As we have proved again and again in recent years, APTA is a force to be reckoned with. I am well aware that what we have accomplished--and will continue to accomplish--could not have happened without the strong and visionary leadership of recent times. Throughout our history, APTA has been blessed with dedicated and inspiring leaders. And we are particularly fortunate that these leaders can be found not just in national office but at every level throughout this Association.

I'd like to take this opportunity to thank each of you who supports this Association--through thick and thin:

* The hundreds of you in the Key Contact program, who have helped health care policymakers understand the need for our services.

* The hundreds of you who helped develop the Guide, and the Normative Models, and the Clinical Research Agenda.

* Those of you who use your knowledge and expertise to educate third-party payers in the quest for fair and appropriate reimbursement.

* All of you who set Association policy as delegates.

* The chapter, section, and assembly officers who devote thousands of hours of volunteer time to serve your constituents.

* Those who serve on component public relations committees, and the thousands of members who help spread the good word about physical therapy through health fairs, fitness clinics, and other public awareness efforts.

* The members of the Annual Conference Program Committee, who make possible so much of what we will experience here this week.

* Component newsletter and journal editors, and the manuscript reviewers and editorial board members of our own journal, Physical Therapy.

* All of you across the country who are fighting the good fight in your state legislatures for direct access, for protection of the term "physical therapy," and for the right to perform spinal manipulation.

* And all of you who are urging other physical therapists and physical therapist assistants to join the Association, to participate, to help make our collective voice stronger.

Like the physical therapy pioneers before you, you are making history.

Physical therapy would not exist as we know it--nor would its future be as bright as we anticipate it will be--without you, the members of the American Physical Therapy Association. And APTA would not exist without you. It's that simple. What you do each day in your clinics, in your classrooms, and in your research centers--and what you do for your profession as members of APTA--is no less than extraordinary.

References

(1) Guide to Physical Therapist Practice. 2nd ed. Alexandria, Va: American Physical Therapy Association; 2001.

(2) A Normative Model of Physical Therapist Professional Education: Version 2000. Alexandria, Va: American Physical Therapy Association; 2000.

(3) A Normative Model of Physical Therapist Assistant Education: Version 99. Alexandria, Va: American Physical Therapy Association; 1999.

(4) Clinical Research Agenda for Physical Therapy. Phys Ther. 2000;80: 499-513.

BF Massey Jr, PT, 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 2001: The Annual Conference and Exposition of the American Physical Therapy Association; June 20, 2001; Anaheim, Calif.

Adapted by permission of the American Physical Therapy Association from Massey BF Jr. "We have arrived!" PT Magazine. 2001;9(9):46-48.