December 2005

Straight Talk

By David G. Greathouse, PT, PhD, ECS

Continuing to expand and define PT clinical specialist certification will usher in positive change

Clinical specialization certification in physical therapy originated in 1976 when the APTA's House of Delegates (HOD) approved the concept of specialization and established the Task Force on Clinical Specialization. The HOD's charge to this task force was to investigate the feasibility of developing a certification process with further direction that the process must be valid, legally defensible, attainable, and fair. Now, 30 years from the charge of the Task Force and 20 years after the first examination offering, the certification process for clinical specialization in physical therapy has been realized as an overwhelming success, and it continues to be valid, legally defensible, attainable, and fair.

There are now 5,282 certified clinical specialists in physical therapy. From 1985 until 2004, there has been a steady growth in the specialization process. The number of certified clinical specialists is now 10% of the total number of physical therapists that are APTA members (5,282/50,500). The largest number of certified clinical specialists are in the area of orthopedic physical therapy followed by those in pediatric and geriatric physical therapy. The 30 to 39 age group contains the largest number of certified clinical specialists according to age followed by the 40 to 49 age group.¹ The top five work settings of certified clinical specialists are: private PT office, hospital, academic institution, outpatient facility, skilled nursing facility.¹ The top four professional positions of certified clinical specialists are: supervisor/director of PT, staff or senior PT, sole owner/partner PT practice, academic faculty.¹

The specialist certification examinations are now offered once per year, and are computerized and administered at centralized testing centers. The examinations consist of multiple-choice questions that include case scenarios and are based on the description of specialty practice (DSP) for each clinical specialty area. The minimum eligibility requirements include:

• Current license to practice physical therapy in the United States;
• 2,000 hours of direct patient care in the specialty area; and
• 500 hours (25%) of the direct patient care must have occurred in the last 3 years.

Certification requires advanced knowledge in patient care, teaching, interpretation of research, administration, consultation, and communication. Specialty councils may allow completion of an APTA-credentialed clinical residency to replace all or a portion of the practice eligibility requirements.¹

THE NEXT STEPS
The strides taken in establishing the PT certification process and its acceptance by the medical profession have been quite successful over the last 30 years, but in order to turn physical therapy into a "doctoring profession," more must be done.

The APTA vision statement for Physical Therapy 2020 states that:

• Physical therapy will be provided by physical therapists who are doctors of physical therapy (DPTs) and who may be board-certified clinical specialists.
• Consumers will have direct access to physical therapists in all environments for patient/client management, prevention, and wellness services.
• Physical therapists will be practitioners of choice in clients' health networks and will hold all privileges of autonomous practice.

One component that directly impacts advanced clinical practice and specialist certification is physical therapy professional education. Presently, 57% of the professional education programs in physical therapy in the United States offer the DPT degree, and approximately another 30% of programs are transitioning or moving toward awarding it. It appears that the physical therapy profession and its educational programs have expeditiously moved toward making the DPT the professional degree for physical therapists of the future. Second, another component that impacts specialist certification is direct access to or direct contact with physical therapy services. I believe that through the legislative efforts of the APTA, direct access to physical therapists will become a reality. The United States Army and other uniformed military service physical therapists as well as PTs in the Kaiser Health system and Veteran Affairs system have demonstrated that the model for direct access to or first contact with physical therapy services provides:

• Prompt evaluation and treatment for patients with neuromusculoskeletal complaints;
• Promotion of quality health care;
• Decrease in sick call visits;
• More appropriate use of physicians;
• More appropriate use of PTs' education, training, and experience.²

Direct access to or contact with physical therapy services by military, Kaiser, and VA PTs has been shown to be safe and efficient and provides optimal evaluation and intervention of patients with neuromuscular dysfunction.

In addition to the autonomous role envisioned for clinical specialists, does it appear that the future will mandate changes to the clinical specialist certification process? One of the options for the future of physical therapy clinical specialist certification would be to maintain the status quo. Bella J. May, PT, EdD, FAPTA, in her address at the 2000 Combined Sections Meeting (CSM) in New Orleans stated that physical therapists will face many crossroads and opportunities on their professional journeys and her hope was that while on these journeys we would ignore the well-traveled path, the path of the status quo. My address at the 2005 CSM meeting echoed May's, rejecting the path of the status quo for the future of physical therapy clinical specialist certification.

ELEMENTS FOR ADVANCEMENT
In my 2005 address, I outlined three key elements for the advancement and future of physical therapy clinical specialist certification.

Clinical internships placed at the end of the didactic and preliminary clinical education experiences and lasting a minimum of 1 year will be incorporated into the future curricula of physical therapy professional doctorate programs. These internships would have "general" components, ie, acute care, rehabilitation, and outpatient, as well as the opportunity for clinical specialization. Internships will create more opportunities for DPT students to be exposed to clinical specialization and the specialization process.

There needs to be an increase in the number of APTA-certified residency programs in the seven existing areas of PT specialty practice. In addition, a specialty area in "general practice," like a family practice in medicine or general practice in dentistry, needs to be created with certification in this clinical specialty as the goal of this process. Other specialty areas that are not presently offering residencies or opportunities for clinical specialist certification may also move in this direction as the specialty areas are identified and defined. As the number of certified residency programs increases, the opportunity for joint internship/residency programs in a clinical specialty area may also be created. Thus, additional opportunities for clinical specialization will be afforded new graduates and other PTs already in the workforce.

The third element is a positive change in financial status as a result of becoming a certified physical therapy clinical specialist. Board-certified specialists in medicine and dentistry realize financial compensation as a result of this advancement in their professional careers. Since the mid 1990s, the United States military services have provided incentive pay for their physical therapists that have attained board certification in their clinical specialty. At present, 55% of the 183 active duty US Army physical therapists are board-certified clinical specialists by the ABPTS. Thus, board-certified physical therapists in the military are recognized and rewarded for their advanced clinical competency. In a recent survey, 39% of all employers of board-certified physical therapists stated that a salary increase would be considered as a result of obtaining specialist certification. If enacted, the increase in the financial incentive for PTs who obtain board certification in the future will be a driving force, creating a tangible incentive for the additional work needed to achieve certification.

As the physical therapy profession becomes a doctoring profession, the opportunity for an increased presence of clinical specialization and board certification will become a reality. The future model of clinical specialization in physical therapy may follow the model currently in place for the profession of dentistry. A dentist completes his professional education in dentistry and then has a choice of practicing or engaging in a clinical residency program. There is an option of a residency in general dentistry. Typically, the residency program in dentistry is 2 years in length and, upon completion, most dental residency programs offer a master's degree in that particular specialty area and the opportunity to sit for the board certification examination. The dental board certification process is voluntary, unrestrictive, and coordinated. This model could also be adopted as the profession of physical therapy moves toward the APTA vision for 2020.

David G. Greathouse, PT, PhD, ECS, was professor and chairman of the School of Physical Therapy, Belmont University, Nashville, Tenn, at the time this manuscript was written. He is currently the director of Clinical Electrophysiology Services, Texas Physical Therapy Specialists, New Braunfels, Tex, and is an adjunct professor at the US Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, Tex. This column was adapted from his address to the APTA's Combined Sections Meeting in New Orleans in February 2005.

REFERENCES

1. Available at: www.apta.org/Education/specialist/. Accessed November 15, 2005.
2. Greathouse DG, Schreck RC, Benson CJ. The United States Army physical therapy experience: evaluation and treatment of patients with neuromuscular disorders. J Orthop Sports Phys Ther. 1994;19:261-266.

LOOKING FOR EXPERT ADVICE? Experts here are available to answer all your questions! Please contact us for more information about this feature, or to become an expert.

MEDIA CENTER Interactive Media  Archives  · December 2008  · November 2008  · October 2008  · August/September 2008  · Fall 2008 Product Directory  · July 2008  · June 2008  · May 2008  · April 2008  · March 2008  · All Archives  Newsletter  · Rehab Today Resources Classifieds Calendar Consumer Resources Media Kit Advertiser Index EAB Reprints Submit an Article