Laura Finucane (second left) and the panel listen to audience comments

Specialisation: is there a danger of the profession losing its holistic outlook?

Lively congress sessions allowed delegates to explore the possibilities, challenges and practicalities of specialisation and advanced practice – and the prospect of moving into independent prescribing as they specialise.

Audience participants at a discussion session about the specialist role expressed fears that the profession could become boxed in by specialisation. Shouldn’t physical therapy be less inward-looking, and specialise in areas dictated by society’s needs, rather than the areas people want to work in?

One of the speakers, Laura Finucane, a consultant musculoskeletal physiotherapist in spinal conditions from the UK, agreed that specialisation could go too far. “We want to get away from the ‘I can’t deal with it, I’m a specialist’ ethos,” she said. “We all have to be able to look at complex problems and look at patient holistically.”

She disagreed with audience members who suggested that medicine provided a model for physical therapy – with different types of specialists and generalists equally valued. To maintain a holistic outlook, she said, the profession should be aiming for a split of 80% generalists and 20% specialists.

But others thought this underestimated the importance of specialists. Hans Hobbelen, a professor in healthy lifestyles from the Netherlands, thought that generalists should always try to refer to a more specialist colleague when they could. Jon Warren, an assistant physiotherapy professor from New Zealand, agreed that there was a danger of generalists treating in specialist roles – it was important that everyone knew where their boundaries lay.

Many participants commented on the need for better definitions and guidance in the field of specialisation and advanced practice. Was it WCPT’s role to provide international clarity and direction?

Emma Stokes, WCPT President, said that the Confederation was starting work on a thought leadership paper to reflect the diversity of opinion on the subject. Guidelines and a new policy could follow. She emphasised the importance of looking beyond the perspectives of privileged parts of the world, and addressing the issue as a global physical therapy community.

“It would be amazing to have a set of advanced competency guidelines,” she said.

Meanwhile, in a separate discussion session, participants considered the prospect of widening prescribing rights in the profession, as part of the move towards advanced practice. Representatives from the profession in the United Kingdom provided perspectives on their successful campaign for physiotherapists to be granted full independent prescribing rights in 2012. UK physiotherapists are the only PTs in the world to have this right.

Natalie Bestwetherick, Director of Practice and Development at the Chartered Society of Physiotherapy, said that gaining support from doctors, pharmacists and the public was critical in achieving the new rights. It was also important that the move aligned with the policies of the UK government at the time.

It followed a history of the profession in the UK changing its scope of practice, proving its value in addressing capacity problems in areas such as orthopaedics, and the precedent of nurses also acquiring prescribing rights.

“Every country will have a different history which may help or hinder moving forward in this field,” she said.

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