APTA’s Vision 2020: Was it Abandoned in 2013?

In 2013, the APTA removed the original Vision 2020 statement from http://www.apta.org that was first approved and released in 2000. The APTA replaced the 2020 statement with a new vision statement, which was adopted and approved in 2013. The original Vision 2020 statement reads:

“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, activity limitations, participation restrictions, and environmental barriers related to movement, function, and health.”1

The original Vision 2020 statement had 6 guiding principles: autonomous physical therapist practice, direct access, doctor of physical therapy and lifelong education, evidence based practice, practitioner of choice, and professionalism.1 However, the new “Vision Statement for the Physical Therapy Profession” simply reads, “Transforming society by optimizing movement to improve the human experience.”2 Notably, the replacement vision has 8 guiding principles including: identity, quality, collaboration, value, innovation, consumer-centricity, access/equity, and advocacy. 2

While both statements attempt to predict how the physical therapy profession will fit within the broader U.S. healthcare system, making direct connections between the two visions is difficult. In other words, the new vision does not appear to be a continuation and/or update of the previous vision but rather more of a new line of thought and direction. Importantly, I am not being critical of either vision statement; in fact, I find merit and importance in the meaning and guiding principles of both.

During the release of the new vision statement in 2013, the APTA stated, “the values of Vision 2020 remain significant to the successful fulfillment of the new vision.”2 However, if we hold this statement true, then the success of the new vision is dependent upon the successful fulfillment of the old one. Yet, the original Vision 2020 statement seems abandoned as we moved on to what presents as an alternative set of goals with the introduction of the new vision. This begs the question, why? Was the 2013 vision statement created because the 6 goals in Vision 2020 were already achieved? If so, the APTA should publicly acknowledge how each goal was accomplished. At a minimum, the APTA should publish the instruments and/or outcome measures used to demonstrate quantifiably the achievement of the original 6 goals.  To our knowledge, such information has never been distributed to the profession. In fairness, the APTA did provide some rationale supporting the need for a transition to a new vision and made the process of the transition to a new vision as transparent as possible through posting numerous documents that led to the production of the new vision.3,4 However, no discussion of objective outcome measures are found within these documents, and notably, only the opinions of 13 APTA Board members are given to support the change.4 That being the case, perhaps the replacement of the original Vision 2020 statement was a “bait and switch” strategy to avoid having to explain why the profession has only met 3 (or maybe 4 depending on your state) of the 6 goals in the original Vision 2020 statement.5

The original Vision 2020 statement asserted that physical therapists would become the “practitioner of choice” for the diagnosis and treatment of “movement, function and health” conditions; however, a recently published study in the Journal of Physical Therapy Education6 found otherwise. Kearns et al6 investigated the practitioner of choice for health care consumers in an array of conditions physical therapists possess the ability to treat.6 While the scope of this research was limited to Western NY, the results indicate that MDs are still the practitioner of choice by large margins for 16 of the 17 medical conditions related to movement, function, and health.6 Although just a single study, I believe that the findings of this study represent the broader profession. In light of this research, I question whether this component of Vision 2020 was ever truly achieved. Furthermore, based on the large margins by which MDs were selected over physical therapists, there is still a significant amount of ground to cover to reach the ideas encompassed in the original Vision 2020.6

In addition, Kearns et al.6 investigated health care consumer knowledge of the skills and training that medical professionals possess to treat a wide array of medical conditions.6 The results showed a greater than 20% discrepancy between the selection of PTs as a practitioner of choice and the identification of PTs as having the skills and training to treat 13 of the 17 medical conditions.6 This discrepancy clearly reveals that the physical therapy profession has a serious branding issue. The public has limited knowledge of what PTs can treat, and to an even greater degree, an inadequate understanding of their ability to see physical therapists without a physician’s referral, as permitted in a majority of states.6 A recent systematic review by Ojha et al.7 found that a lack of public awareness and limited third party reimbursement were the two primary barriers preventing physical therapists from seeing patients directly without referral by a medical physician. In short, the public doesn’t know what physical therapists treat or how we go about treating it. Again, based on this evidence and vantage point, it appears Vision 2020 was not fully achieved. Even more concerning, I believe that the updated Vision 2020 statement provides little to no help with the physical therapy branding problem. Does “Transforming society, by optimizing movement to improve the human experience” better inform the public of what we do as physical therapists? I can’t even seem to remember the new vision statement correctly no matter how many times I try to recite it!

In summary, I wonder if the APTA is willing to provide an update on the original 6 components of the Vision 2020 statement. Have these goals been accomplished, and, if so, what quantifiable measures demonstrate success? If not, does the APTA expect that the original goals will be accomplished by 2020? If we did not achieve all 6 of the items in the original Vision 2020, would it not perhaps be better to admit it rather than attempt to sweep Vision 2020 “under the rug” and replace it with a single sentence 7 years before the deadline. Clearly, the APTA (i.e. us as members!) has left many ends untied regarding Vision 2020.

AUTHOR:

Matthew S. Kearns, DPT, Cert. SMT, Cert. DN, Dip. Osteopractic
Fellow-in-Training, AAMT Fellowship in Orthopaedic Manual Physical Therapy
Farmington, NY

REFERENCES

  1. Vision 2020. (n.d.). Retrieved December 9, 2014, from http://www.apta.org/vision2020/.
  2. Vision Statement for the Physical Therapy Profession and Guiding Principles to Achieve the Vision. (n.d.). Retrieved December 9, 2014, from http://www.apta.org/Vision/.
  3. Staff, M. F. (2013). Moving Beyond Vision 2020: Join the Discussion.
  4. Untitled Page. (n.d.). Retrieved March 31, 2015, from http://www.apta.org/BeyondVision2020/TaskForceReport/2013/4/25/.
  5. Physical Therapy Goals for 2020 Well on Way to Fruition on Medical News Corporate. (n.d.). Retrieved March 31, 2015, from http://www.medicalnewsinc.com/physical-therapy-goals-for-2020-well-on-way-to-fruition-cms-85.
  6. Kearns M, Ponichtera N, Rucker T, Ford G. Physical Therapists as Practitioner of Choice: Consumer Knowledge of Practitioner Skills and Training. Winter 2014;28(1):64-72.
  7. Ojha HA, Snyder RS, Davenport TE. Direct access compared with referred physical therapy episodes of care: a systematic review. Phys Ther. 2014 Jan;94(1):14-30. Epub 2013 Sep 12.