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Home > A Comparative Analysis of Orthopaedists & Physiotherapists (Physical Therapists): Roles, Training, and Specializations

A Comparative Analysis of Orthopaedists & Physiotherapists (Physical Therapists): Roles, Training, and Specializations

First, let’s address the confusion surrounding the term physiotherapist. Physiotherapists (a term used in the British Commonwealth, Europe, and many parts of the world) and physical therapists (the nomenclature used in the United States) are healthcare providers who perform the same jobs, and the names can be used interchangeably.

This article will highlight the similarities and distinctions between orthopaedic physicians and physiotherapists/physical therapists and better define their roles, training, and areas of specialization. These two healthcare professionals play integral and complementary roles in the management and treatment of musculoskeletal conditions. While both professionals are involved in the care of individuals with orthopaedic issues and their goals often overlap, there are significant differences. By providing a comprehensive comparative analysis of both professions, we are shedding light on their unique contributions to the field of orthopedic and rehabilitative medicine.

Musculoskeletal conditions are a common and significant health concern worldwide, often requiring specialized care and management. Orthopaedists and physical therapists (physiotherapists) provide crucial services in the diagnosis, treatment, and rehabilitation of patients.

Orthopaedists

Orthopaedists, also known as orthopedic surgeons, are medical doctors who specialize in the prevention, diagnosis, and treatment of musculoskeletal conditions. They undergo extensive medical education, including a bachelor’s degree, medical school, and residency training in orthopedic surgery. Orthopaedists have the authority to order tests, diagnose conditions, prescribe medications, and perform surgical interventions. They primarily focus on surgical management, including joint replacements, fractures, ligament repairs, and other invasive procedures.  They also refer patients to other specialists for care, such as Interventional Pain Management or Pain Psychology when appropriate.

Physiotherapists

Physiotherapists, known as physical therapists in the United States, are allied healthcare professionals who specialize in the assessment, non-surgical treatment, and prevention of physical impairments and disabilities. They hold a bachelor’s degree in a health sciences related field, or doctorates in physical therapy and are trained in various techniques such as manual therapy, exercise prescription, and electrotherapy. Physiotherapists work closely with patients to restore physical function, relieve pain, and promote overall well-being. They emphasize non-surgical interventions, including therapeutic exercises, modalities, and patient education.

Training and Education:

Orthopaedists undergo a rigorous and extensive educational pathway that includes four years of undergraduate studies, four years of medical school, and approximately five years of residency training in orthopedic surgery. Orthopaedists receive comprehensive medical training, including in-depth knowledge of anatomy, pathology, and surgical techniques.  Most orthopaedists now choose to complete at least one year of Fellowship training in a chosen specialty area which is a concentration in surgical experience and hands-on treatment of a specific orthopaedic area of practice, such as spine surgery, hand surgery or pediatrics.

Orthopaedic physical therapists typically complete a four-year undergraduate degree (Typically health sciences) or in a major that will cover all pre-requisite courses required to enter a DPT or MD program. There is no pre-Physical Therapy major in the United States. This is followed by three years of physical therapy school, where they will obtain their Doctor of Physical Therapy degree.  Some will move on to a residency or fellowship.

Based on our research, all master’s in physical therapy programs, which required two years of study with fifteen weeks of clinical experience, have now been converted to doctoral programs.  A Doctorate in Physical Therapy is a three-year program, including a year of clinical practice. The primary reason the field of physical therapy moved to a doctorate degree was to provide adequate education for physical therapists to evaluate patients directly and determine if the patient is appropriate for PT or needs to be referred to another healthcare practitioner (orthopaedist, neurologist, etc.).

Scope of Practice and Specializations:

Orthopaedists have a broad scope of practice and can diagnose and treat a wide range of musculoskeletal conditions. They often specialize in specific areas, such as spine surgery, joint replacement and revision, sports medicine, pediatric orthopaedics, or foot and ankle surgery. They are licensed and authorized to order diagnostic tests, prescribe all classes of medication and to perform in-office procedures, as well as surgical procedures in ambulatory surgical settings as well as in hospital settings.  They are authorized to admit patients into and discharge them from hospitals.

Orthopaedists are typically surgeons; however, there are some who only do non-surgical medical management.  They usually work for orthopaedic specialty groups which may be independent or owned by hospital systems.  Some orthopaedic physicians are employed by sports teams (think NFL or NBA) or by large corporations.

In contrast, orthopaedic physiotherapists specialize in non-surgical interventions, including orthopedic manual therapy, sports rehabilitation, geriatric care, and neurorehabilitation. They may also get certifications in specialty areas such as dry needling, cupping, or blood flow restriction therapy. They work closely with orthopaedists and other healthcare professionals to provide comprehensive care to patients.   They may use a wide range of therapeutic modalities, including but not limited to heat, cold therapy, laser therapy, ultrasound therapy, traction, etc.

Orthopaedic physical therapists can accept referrals from a physician from any field of medicine or non-physician practitioner.  Physical therapists can also evaluate and treat patients directly, without a referral.  Some restrictions apply depending on the state.  Beginning July 1st, Virginia restrictions on treatment time frames under direct access care will be removed (formerly patients could be treated no more than 60 consecutive days, now no restriction). 

Orthopaedic physical therapists cannot admit patients to the hospital, nor may they prescribe medications or order diagnostic tests (excepting Military and civilian contract Physical therapists who can order diagnostic testing while working for the Military). They report findings to the orthopaedist (or other provider) with whom they are working and may recommend such tests for further investigation of findings.

Orthopaedic physical therapists typically work in outpatient settings such as private practice, physician-owned practice, or hospital-based outpatient clinics.  They may also work with professional sport teams, collegiate athletic programs, with high schools, and even large employers.

Collaborative Approach

Orthopaedists and physical therapists frequently collaborate in the management of patients with musculoskeletal conditions. Orthopaedists may refer patients to physiotherapists for non-surgical interventions, pre-operative conditioning or post-operative rehabilitation, or ongoing physical therapy. Physical therapists play a crucial role in assisting patients in their recovery, maximizing functional outcomes, and preventing further injuries. This collaborative approach ensures holistic care and optimal patient outcomes, assisting the Orthopaedic physician in managing the care of the patient’s condition, whether acute, chronic, or surgical in nature.

 

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