Change is uncomfortable—however necessary it may be. And that uneasiness prevents many individuals and groups from seeking the kind of change that is vital to growth. This trend of paralysis is all too common in the physical therapy space, and in my mind, one glaring example of something desperately ripe for change is our lack of standardization—in terms of brand perception, patient experience, and clinical outcomes. And one way we can begin bridging that gap is to re-evaluate our existing CEU standards.
This issue clearly spans to occupational and speech therapy as well, but for this piece, I am going to focus on the PT world. Currently, there is no clear consistency in physical therapy school curriculum or continuing education requirements from one state to another. So, physical therapy students—and practicing therapists—in different states may learn different protocols or be held to different standards. And that, in turn, means patients in different states may have vastly different care experiences. While this certainly isn’t the sole reason behind the often-discussed physical therapy branding problem, it doesn’t do much to foster a more cohesive consumer perception of our profession in terms of the customer experience we deliver. During her session at this year’s APTA’s NEXT conference, Tara Jo Manal, PT, DPT, FAPTA, emphasized the importance of unifying industry standards in order to “not only…help improve patient care, but also…reduce provider confusion and disorganization.”
Now, that’s not to say that standardization means physical therapy treatment is “one-size-fits-all,” but the push for consistency does align with the concept of evidence-based practice. It also creates an ideal landscape for collecting and effectively leveraging outcomes data—and that’s a win-win for patients and PTs alike. Finally, it opens the door to greater regulatory flexibility, especially when it comes to practicing across state lines—something that is becoming increasingly relevant in the age of interoperability and telehealth.
Opening the Reciprocity Door
Standardization offers physical therapists a clear—and, for the most part, easy—path to practicing in another state. But if we’re going to increase patient access to PT by making it easier for therapists to work across state lines—and we should—then we should probably start thinking about the additional challenges that come with practicing outside our home states (i.e., the states where we originally received our licenses). One of those challenges is consistently delivering care that meets state expectations as well as patient expectations.
Maintaining Legislative Momentum
There’s no question that the physical therapy profession—and the laws governing physical therapy practice—is in a state of flux, and as I see it, that’s not necessarily a bad thing. Just last month, in fact, Congress announced it had reached a bipartisan agreement to eliminate the therapy cap. We’re starting to see some real changes taking shape, and that makes me incredibly optimistic about the future of our profession. And going back to the topic of practicing across state lines, another recent movement that has me hopeful is the Physical Therapy Licensure Compact. A few years ago, this seemed like nothing more than an idealistic fantasy. As of today, though, 14 states have joined the compact. That exceeds the 10-state requirement, thus making this dream a reality. But, what about the other 36 states? Could our profession’s reluctance for change and lack of uniform continuing ed standards be holding this effort back?
Many state-level legislators still need convincing, and continuing competency standards are one of the stronger arguments against implementing an interstate licensure compact for PTs. Right now, each state has its own educational standards for PTs, which govern both initial college education requirements as well as continuing education criteria.
Prioritizing Patient Safety
So, in the eyes of some lawmakers, accepting therapists from a state with less-stringent standards presents an inherent liability risk. For example, lawmakers in Illinois, Oklahoma, and Florida have rejected their states’ attempts to join the compact, and while it’s not yet clear why, I don’t think it’s a stretch to deduce that license and safety standards played a role. Oklahoma, for instance, requires 40 hours of continuing competency training during the two-year pre-renewal period. If a provider were to travel to Oklahoma from Arizona—where the standard is 20 continuing competency hours within two years—he or she would barely meet 50% of Oklahoma’s CEU requirement. That’s a pretty significant difference, and it’s easy to see why Oklahoma health officials might have concerns about patient safety and care consistency.
Nationwide standardization of educational requirements—including those governing mandatory CEUs—would theoretically help ease those concerns and thus, make state license reciprocity that much easier to attain.
Meeting Patient Expectations
These types of discrepancies should be concerning to patients as well. According to this article from the Federation of State Boards of Physical Therapy, during a summit put on by The Citizen Advocacy Center (CAC), the group reported that “patients have every right to assume that a healthcare provider’s license for practice is the government assurance of his or her current professional competence, and clinicians themselves would like assurance that those within the practice are current and fully competent.” To me, these expectations are a no-brainer; patients absolutely should expect to receive safe care in a safe environment, no matter which state they’re in.
Exploring Other Options
Some opponents of the licensure compact argue that the industry should explore other options —specifically, options that would not require a massive overhaul of the licensure process. One suggestion is to expedite the current board approval process. However, that would mean hiring additional board staff to increase efficiency. And while this would certainly temper the frustration of waiting months to receive your license, it wouldn’t solve the standardization issue plaguing the PT community. Furthermore, it wouldn’t alleviate the financial burden of applying for a new license—and in some cases, retaking the state exam—each time a provider wishes to work outside of his or her home state.
Building a Plan that Works
If this all sounds to you like a tangled mess of regulatory red tape, you’re certainly not alone—which is why I advocate for the implementation of continuing education standards that would get every PT across the country on the same page with respect to not only coursework criteria, but also competency. While the current CEU system ensures that you can retain your license in perpetuity as long as you complete continuing ed classes, there’s currently no go-to method of ensuring that every provider actually meets continuing competency standards—that is, there’s no verification process to assess whether the standing CEU requirements are actually boosting a provider’s level of competency.
And that begs the questions:
- Who are providers learning from?
- What kind of education are they receiving?
- How do we make sure those who teach CEU courses are offering the most updated information?
Under the current CEU standards, the answers to these questions leave much to be desired, which is why the CAC developed the following five-step model for improving continuing competency:
- “Develop a routine periodic assessment.
- Devise a personal plan.
- Implement the plan.
- Document the plan.
- Demonstrate and evaluate competence.”
We’ve seen similar concepts work in other medical professions. Nurses have their own licensure compact that’s seen marked success. And as this article from Pew Trusts explains, that success is likely due to the fact that “nurses take the same licensing exam in every state, and states’ licensing requirements are mostly uniform.”
At the end of the day, we should be putting the needs of the patient first. That’s why I advocate for one universal solution—one model of criteria for license renewal and continuing education. This would create standards in safety and experience that patients should already expect from PTs, thus elevating not only our effectiveness as healthcare providers, but also our entire brand. Plus, we’ll help ensure our patients always receive the best possible care—and that’s a goal I know we can all agree on.