Panel Discussion: What About Titles?
What should you call yourself and why do other professionals care?
Examples:
- If a health club chain uses PT to refer to personal trainers, is this a punishable offense?
- Can someone who trains athletes call themselves an “athletic trainer,” or is this a designation that should only be used by ATC’s?
- Should physical therapists with a DPT refer to themselves, or be referred to as doctors?
Moderated by Brent Brookbush DPT, PT, MS, PES, CES, CSCS, ACSM H/FS
This Panel Discussion was originally posted on my facebook page – https://www.facebook.com/brent.brookbush – 10/10/15
What is this professional's title? - http://risewellnesscenter.com/
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Ryan Chow I think I was told in PT school that it is against the law to use PT if someone is a personal trainer in the state of NY. I don't think anyone is going to police this unless a personal trainer starts to do things they're not licensed or qualified to do resulting in dangerous or irresponsible behavior. As for DPT's being referred to doctors, I think as long as it is not in a hospital where it can be confusing, and it is made clear that it is a doctor of physical therapy, then I think we should be called that. If I said hi, I am Dr. Ryan Chow, your physical therapist, I think it is clear and reflective of my education, training, and skill set. If the patient is confused about my capabilities, I can clarify that something is out of my field and refer out. I'm going to refer to myself as Dr. Chow when I finish school and I have made it a career goal to market and publicize what we as PT's are trained and licensed to do. The general public does not understand our training and skill set and it is hurting the healthcare system and preventing many people from seeing a PT directly for things we are better qualified to do than other professionals. I know that's quite vague but I know you understand what I'm saying. I will expound if anyone wants me to clarify smile emoticon
January 23 at 10:57am
Dr. Brent Brookbush DPT, PES, CES, CSCS I found this link Ryan Chow - http://www.ptbc.ca.gov/forms/use_of_dr.shtml - but it's for California.
I mostly agree, but for good measure I think personal trainers should establish and own the credential CPT or CFT… if for no other reason than for branding purposes and having a credential that is uniquely theirs.
I am also with you on the Dr. credential… I obviously refer to myself in publication and am referred to often as Dr. Brookbush. To me (and every other profession outside of M.D.'s) the title "Doctor" denotes a level of education, not a scope of practice.
January 23 at 11:10am
Ryan Chow I agree that the personal training industry should establish their own credential, which should include raising the minimum standard. I know there was a lot of discussion about this in Washington D.C. with PT's deciding their minimum standards but it ultimately did not get approved. It needs to happen to raise the standard of the personal training industry and for the general public to understand who does what.
January 23 at 11:32am
Dr. Brent Brookbush DPT, PES, CES, CSCS Hey Ryan Chow,
The issue becomes what it would do to the work force of personal trainers… for example, if a B.S. or Associates Degree became the minimum standard for personal training, many health club personal training departments would immediately cease to exist.
A personal trainer holding a degree is far more common than when I started in the industry in 1998, but it is still relatively rare.
There is also the issue of compensation. Would we have an eager work force if the barrier to entering the personal training field was degree. This implies a significant investment in time and money. At this point most personal trainers barely make a livable wage. $20 - 45/hour looks great on paper, but when you consider that you only get that money when you have sold training to an individual, you can see where the average trainer only makes between $20 - 40,000/year.
January 23 at 7:10pm
Reegan Emslie Wow I started out writing a comment comparing these issues after experiencing the differences between Australia and the US, and it was massive, so I'm shortening it. I think it comes down to culture. I had professors in the US be very adamant about being addressed as Dr. Xyz, where as here in oz we are on a first name basis with our profs. None of them ask to be called Dr. Xyz, and it may be because I am an Aussie, but I respect them more for that. They may sign documents as Dr. Xyz but you wouldn't address them as that, and if you did they would say "just call me Tim." Physiotherapists are physio's, if you have DPT you are still just a physio and are seen as having the same level education after graduation as someone who graduated from a bachelor or masters entry level program. Personal trainers are PT's and medical physicians (which by the way is a bachelor level program in Australia) are Doctors. All in all, I believe the only time you are allowed to use the designation "doctor" in Australia is if you are a medical physician or have completed a PhD.
January 23 at 4:44pm · Edited
Dr. Brent Brookbush DPT, PES, CES, CSCS I am a bit old school and call people by title (Doctor Last Name, Professor Last Name, etc.) until given permission to do so otherwise, but I agree with you. All my patients and other individuals at the gym where my office is call me by first name. I think that is totally acceptable. I do think that if you received a doctorate regardless of the profession, you have earned the right to be referred to as such.
January 23 at 6:56pm
Reegan Emslie But if you guys are saying that the title "doctor," is a title of academic achievement, it loses all meaning because the DPT is the standard. Yes, academically speaking, doctor is held in high regard, importance, excellence, and achievement above the norm, because it is NOT the standard. How do we then distinguish those who went on to do a PhD or study above the norm? To me, if it becomes the standard title for everyone, it loses meaning
January 24 at 3:52am
Dr. Brent Brookbush DPT, PES, CES, CSCS A PhD is a Doctor, a PDM is a doctor, a DDS or DMD is a doctor, a DC is a doctor, etc…. it is already the standard for anyone with a doctoral degree. My point is it is actually the M.D.'s/Physicians who are the odd ball 4 year clinical doctorate, and the only profession trying to "own" the title. M.D.'s should place more emphasis on educating the public about the scope of a "physician." As far as I am concerned, everyone with a doctorate level of education should be able to sign their work and be addressed as doctor
Reegan Emslie I understand your point. Would you be ok if every allied health field makes a clinical doctorate the entry level degree? I think there will be growing pains for a while as we, and other professions, journey down this road we are on. I did see in your reply to the massage therapist that the change to DPT was part of the process to gain direct access (which I agree. why the heck go through the PCP? It confused me while I was over there and now as a PT student makes me frustrated even thinking about it) does that have to do with US legislation or just public perception? I only ask as Australia has had direct access for many years, yet our entry level degree is still a bachelor degree.
January 24 at 3:58pm
Dr. Brent Brookbush DPT, PES, CES, CSCS It was legislation that PT's were looking to change, and of course the policies of 3rd party payers (insurance).
January 24 at 8:05pm
Reegan Emslie Ah fair enough! I can support that. As long as it's not the profession trying to puff up its chest and say "look at us, we are doctors" or just doing it because we can. Advancement of the profession is worth it. Good chat Dr. Brookbush. I appreciate it
January 24 at 9:57pm · Edited
Dr. Brent Brookbush DPT, PES, CES, CSCS In the United States the physical therapy profession is following in the footsteps of the medical model. Fellowships are becoming more popular and there is some experimentation with residency programs. I am not sure I like the direction, but it is not to puff up and be better than physicians… we are literally following behind them step for step
Desmond L Diaz I find this topic interesting and suspect at the same time .as a massage therapist, I find my title correct. I agree the standard is lower educational wise in most states, but to broad label a profession as unworthy of the "therapist " would be unjust. I have provided lectures on manual therapy for a few schools offering pt,pta and lmt programs and I can tell you while pt and pta programs are standardized, the quality of skill and knowledge is just as erratic as any other schools in any state . Alot of distinctions are fought for money in my opinion. I have studied orthopedic assessment through Whitney Lowe, I have worked for pt clinics in nursing homes ilfs, hospitals, sports rehab,etc. Many PTS I worked with never saw the dpt title as anything more than a way around getting scripts. Or as a political play to cross over to some chiropractic work. Both sides are trying to broaden the scope of practice in order to bill more legally, and squeeze people like acupuncturist, do,massage therapist, etc out of the healing process
January 24 at 2:43am
Dr. Brent Brookbush DPT, PES, CES, CSCS Hey Desmond L Diaz,
I think my criticism of the massage therapy is just… although all practices have their high's and low's in education, all PT programs include courses on assessment and differential diagnosis… that is a minimum standard. However, the lack of evidence-based assessment in massage therapy programs is almost ubiquitous. I am not against massage entering the allied health and wellness fields, but I do think this should be added to the requirements for programs offering a license.
As far as physical therapists and switching to a doctorate. The reason is two fold. The need for an ever increasing breadth of knowledge… and of course direct access. I would hardly call that a negative., though Having to see a primary care physician for low back pain (who likely can't remember the muscles, much less any specifics about orthopedic pathology of the low back) is ridiculous and wasteful.
January 24 at 10:24am
Nicholas Rolnick Dr. Announces to the individual educational attainment. I think it is imperative moving forward to address your patients as such, "Hello X, my name is Dr. Rolnick. I am a doctor of physical therapy and will be taking care of you etc." it establishes credentials and shows you are proud of your education and place in the health care system. I do however take slight pause at anyone who is a personal trainer using the designation PT as this leads to even further confusion of the mass public
Prentiss Rhodes In my limited opinion the title PT always means physical therapist. Ultimately the licensing boards should provide clarity to scope of practice based on the educational requirements. DPT's should be called Doctor as I think the word itself reflects the time studying and applying physical therapy principles. Using the word physician would be different. When you use your title, Doctor, you'd also define your specialty as well….I will never confuse my ophthalmologist for my proctologist…ramble over.
January 23 at 11:18am
Dr. Brent Brookbush DPT, PES, CES, CSCS Wow… great analogy. I know have a visual of accidently bending over and dropping my pants for my optometrist, but other than that lovely visual… love the analogy
Doctor =Level of Education
Therapist, Physician, Optometrist, etc. = Scope of Practice
January 23 at 12:00pm
Desmond L Diaz Also I always thought personal trainers were titled as CPTs (certified personal trainer ), followed by whichever training acronym they were certified from.
January 24 at 2:49am
Dr. Brent Brookbush DPT, PES, CES, CSCS Trainers should be CPT, but many use PT not realizing that this is the credential of a physical therapist.
January 24 at 10:25am
Maurice D. Williams I think our industry is too caught up in titles. Can't we just all get along & call ourselves body transformers?
January 23 at 11:22am
Dr. Brent Brookbush DPT, PES, CES, CSCS The real confusion Maurice D. Williams is not among fitness professionals, but various professions in the allied health field, and all ego aside, it is important that we clarify our titles and roles so the public knows where to go for various issues.
January 23 at 12:02pm
Maurice D. Williams Gotcha Brent Brookbush. Just spicing it up. In all seriousness, personal trainers are Fitness coaches. Physical therapists are indeed doctors & massage therapist are rightly labeled in my opinion.
January 23 at 4:00pm
Steven Roffers I like it when I'm called Awesome… Just sayin'
January 23rd at 10:52am
Dr. Brent Brookbush DPT, PES, CES, CSCS I like it when your called "awesome" too, Steven Roffers. You do have one of the best pages on facebook! But, as a man with many titles, and someone who I know does not care what other call you…. Do you take offense to the way any particular profession refers to themselves? For example, LMT's calling themselves "therapists", DPT's calling themselves "Doctors", or Chirpractors calling themselves "Physical Medicine Professionals"?
January 23 at 11:06am
Steven Roffers In Atlanta, I was the Director of Physical Medicine and Rehabilitation. It was a title that adequately explained what I did there. I was called Doctor Roffers. I was also called a Chiropractor. Anyone providing any therapy is a therapist, so that term applies as well. I worked with DPTs who were called Doctor because they were Doctors of Physical Therapy. We also had a Nurse Practitioner on staff who had a PhD in Nursing so he was called Doctor as well (because he had a doctoral degree).
Dr. Brent Brookbush DPT, PES, CES, CSCS Fair enough, it sounds like we have the same opinion on the use of the title of doctor Steven Roffers.
I do have reservations about Massage Therapists referring to themselves as "therapists". I think there is a perceptions that therapists "treat pain", and the minimum standard of education for LMT's includes very little assessment and differential diagnosis. This is not to say that I have made up my mind, and I am taking a stand against the use of the word "therapist" by LMT's, but it is food for thought.
Where I formerly had my office I worked with a very talented LMT. Assuming that this individual would only be using manual techniques to affect soreness and muscle activity with the intent of optimizing motion, I did not see a conflict when I agreed to the lease terms. What it turned into was any pain patient seeing the "LMT" first (because they had a much lower price point), and many of them wasting a few hundred dollars on massage sessions before seeing me for what was actually arthrogenic or neurogenic pain. After a couple of sessions I would have them "fixed up", and this would of course leave a bad taste in the mouth of the LMT…as if I was "showing them up." Needless to say my office is no longer at that facility.
The reason I tell this story, is in every instance the missing component was proper assessment. Now, we could take this one step further and discuss "Low Back Pain" patients and a differential for Kidney Infection, Cauda Equina Syndrome or Cancer… and how the lack of a subjective eval by LMT's goes from some wasted money to potential life altering decisions, but those cases are in fact rare… and I think the bigger point is the day to day, and what is best for all patients and clients.
January 23 at 11:21am
Dr. Brent Brookbush DPT, PES, CES, CSCS So Steven Roffers, you and myself have the same opinion regarding Doctor. It is a designation that represents a level of education, not a scope of practice. M.D.'s are actually the oddballs, being the only profession fighting for sole use of the title.
As far as "PT" and personal trainer, I think it depends on the context… in a hospital run wellness facility their may be confusion, but in a gym setting I would be willing to bet that if you randomly asked 50 people what does P.T. stand for they would say "personal trainer" or "physical trainer", just because of the environment. I think the use of CPT or CFT by personal trainers is more important to the personal training profession as a means of creating an identity with in the community of medical and health professions
Nicholas Rolnick I think we as healthcare providers must do our share to help minimize confusion of the mass public. Even though physical therapy and other mid-level healthcare providers are transitioning to doctoral level education, it means they have achieved the maximum level of education in their respective fields. But they are formalized programs. Personal training certifications and degrees aren't formalized and association of credentials such as PT with Physical Therapy isn't conducive to distinguishing either of our respective fields. Therefore I definitely agree with Brent that the designation CPT should be used in reference to personal training and PT in reference to Physical Therapy . It's not necessarily for us who are in the field, but the mass public.
January 23 at 12:05pm
Brandon Trujillo Just had this conversation with a member of the Utah Department of Professional Licensing yesterday. Personally I think they are necessary to help the general public make an informed decision about where and by who they have their health care needs met.
However, I find it extremely unethical when state associations use financial donations excetera to influence the legislature to intentionally change the meaning of a word or a title to either monopolize an industry, squash competition, or mislead the public.
For example: A Personal Trainer can advertise that they help people with low back pain and they refer to themselves at John Doe PT. That is meant to intentionally mislead the public and is a hazard to public safety, or The Chiropractor who advertises themselves as Dr. John Doe at Balanced Body Hormone Clinic, or the State Medical Association getting legislation passed that blocks anyone from using the term Dr or Doctor in their advertising unless they are an MD.
Sorry for the length of this post. It actually could go a lot longer and there are many details that too lengthy to dive into on a message board
My overly simplified position on the subject is that for the sake of the general public we do need a system of designation. To protect not only the publics right to make an informed decision, but to also protect the various professions in more ways than I can list here.
Maybe John Madsen and Joe Betz can add some thoughts here.
January 23 at 2:43pm
Joe Betz There is a national campaign to get the title of "Dr" to only be designated to MDs and DOs. They even run ads in the papers and are posting billboardsJanuary 23 at 5:56pm
Dr. Brent Brookbush DPT, PES, CES, CSCS I mentioned in previous posts that I think M.D.'s trying to monopolize a designation that is actually a level of education is ridiculous. If they spent as much money advertising the scope of a "Physician" and worked to brand that designation they would get much further and offend fewer individuals (Joe Betz).
Interesting points Brandon Trujillo, I had never thought about how the context of the title in association with the name of a business can change public perception.
As a personal trainer of 17 years, someone who trains personal trainers and now a physical therapist, I am very clear in my courses that personal trainers can advertise that they optimize movement through exercise, but should refrain from addressing pain and do not have the scope to perform manual techniques other than stretching
January 23 at 7:02pm