Historical perspectives of autonomy within the medical profession: considerations for 21st century physical therapy practice.

As a part of the American Physical Therapy Association's (APTA) vision statement, by the year 2020, physical therapists "will hold all privileges of autonomous practice." This vision statement and the ideals held within it are elemental to the direction of our continued growth as a profession. Many members and nonmembers, however, appear confused and perhaps even intimidated by the concept of autonomous practice. This paper will review and discuss the processes used by other health care professions to gain autonomy within the US health care system. In particular, the processes used by physicians, which were extremely effective and have been used as a template by many other health professions, including physical therapy. Further discussion will focus on the physical therapy profession, emphasizing the parallels with medicine and considering many issues relevant to the goal of autonomous practice. By understanding the past and considering the present, readers will develop an appreciation of (1) the foundation for autonomous practice in health care, (2) the vision of the APTA and why the profession is well positioned to achieve this vision, and (3) the factors we need to consider to hold (and maintain) all privileges of autonomous practice.