Back from CSM where there was a record in attendance including over 4,000 students. Lots of content and discussion around PT education. This blog has maintained for many years that the state of affairs of PT education is best described as broken. While higher education is being referred universally as a crisis or “bubble” due to unsustainable tuition increases, less state support, and an average debt of $25,000 per student, this blog post which occurred in Chicago during CSM best describes how much more trouble PT education is than many other degrees.
Representing the concerns as a private practice owner, I was asked to present such a perspective at APTA national Rothstein debate in 2008 (summary 7th down and requires APTA membership and login). My concerns at that time and even more so currently can best be summarized as follows:
-Have seen good schools with good students produce inconsistent and variable graduates because of their last internships. Over the years, I have asked over 20 DCE’s (the PhD matchmaker position at PT schools) and 100% of them have admitted to taking a chance on certain student placements and/or putting students in clinicals that they new were not in the student’s best interest. Inconsistent and variation are the hallmarks of PT outcomes-no surprise as to one of the reasons this occurs.
-Lack of preparation by new graduates for the dynamics of practice-namely its high regulatory environment, socially complex situations, electronic documentation, productivity concerns, customer service, and accountability of outcomes. I contend this is mainly due to the lack of structure of clinical education coupled with too short of internships to acquiesce the necessary tacit skills and medical environmental issues that can never be part of a classroom setting.
-Cost of education. This has climbed considerably and it is no longer unusual to have students with well over 75k in debt. In an environment with declining reimbursement, there is little to believe that the educational investment can be recaptured. Salaries are not in step with education costs. My long term concern here is that the best and the brightest will not opt into PT. We all know more than one PT who opted for the highest salary position available rather than the best situation for their long-term career.
Starting around 2006, I began hanging around a group that can best be described as “academics anonymous”. This brought additional insights and great discussions around a better mousetrap. Certainly, the inspiration of schools like MGH and University of Pittsburgh that made such changes within a vertical oriented system gave more than ample confirmation that a clinical education model could be achieved which results in better prepared graduates at a significantly lower cost. Unfortunately, the movement is not occurring fast enough. I am confident in the leadership of the Private Practice Section who has had a working task force on this topic for a few years will produce some additional solutions.
There have been several ideas on this discussed at national meetings including Graham Session of PPS. Without endorsement, here is a broad list of some of them:
-spending a year in a terminal internship where students can be subsidized directly or payment made from employer to school thus reducing tuition cost
-allowing PT students after their second year to take the PTA exam and thus allow some reimbursement for their services while they are doing a year in the clinic (let’s face it, CMS is never going to change their rules on PT students in an outpatient environment). We all know PT students that failed national licensure and subsequently became PTA’s by simply taking its exam
-graduating students with a master’s after two years and a few months into their year internship which would allow them to take licensure exam. Upon completion of the internship they receive their DPT. While I think this is a great idea, the odds of any school reducing their program length and giving up that revenue is less than the odds of me winning the powerball lottery. Remember, it was the academic community that facilitate such a fast transition to DPT (not APTA) in large part as a revenue enhancer
-lower tuition by 1/4 by providing innovative, efficient, and accelerated curriculum such as flipped classrooms and by dramatically reducing tuition costs during internship (also serves the purpose of program’s using master clinicians from the community leading lab sessions and pushing lecture content to “best in class” professors)
The emphasis to change clinical education is going to have to be driven from the private market in my opinion for the simple reason that I don’t think many schools see their model as problematic. With 215+ programs producing 7500+ PT’s and frequent reports over the need for more physical therapists, there is little need for PT schools to do anything more than expand and increase tuition.
A few weeks ago, after 4 years of testing the concept with the US Army-Baylor University program, we (EIM) released our attempt at a solution which can be adapted by programs that are not vertically integrated which is described at this website. While we have received lots of enthusiasm (and thankfulness by students in the program), we have also received our fair share of criticism which is understandable. Our goals are to place students in a more traditional medical model by partnering with private practices and others where 2-3 students per CI work alongside residents and Fellows for about a year, receive structured instructional modules via a learning management platform (including radiology and pharmacology where it can best be clinically assimilated), clinical outcomes are performed by national 3rd party, EMR is standard, and regulations and payment policy issues can be better experienced. The average student is in the clinic for 32-36 hours so that they are given ample time for instruction and lab time with fellow students. We believe that this partnership between academic programs and practice will be the “secret sauce” in achieving our goals. There are plenty of sites committed to residency, fellowship, and board certification who make great integrators of this model.
Lots of discussion at CSM and in particular on twitter of this topic (unfortunately no hash tag). In an attempt to continue the great discussion that we had from John’s post and the post conference fever that prevails for a few days, we would like to continue the conversation with input from PT students, PT’s, and academia. Let’s hear it!
@physicaltherapy
