This recent opinion piece in the NYTimes and blog post in the Harvard Business Review has many parallels to the transformation that has to (and I believe will) happen within the PT profession over the next 10 years, primarily a reduction in the number of years that students are on the “tuition dole” from a typical 3 years to closer to 2. As it currently stands, PT students already pay tuition during their final year, with the vast majority of that time being spent in a clinical affiliation setting where the university is actually providing very little in direct services in exchange for those final year tuition $s. I can already hear DCEs around the country shudder in reaction given the amount of administrative time they invest in matching students to clinical affiliations, visiting clinical affiliation sites and students, etc. However, even this is a highly inefficient process that itself needs reform (and one we’ve discussed here previously), primarily through the adoption of longer term internships with a standardized curricula that leverages peer learning and collaboration similar to a medical residency model (which btw is in stark contrast to our current disjointed 1:1 instructor:student model in which experiences are highly variable between clinical affiliation sites that are, at best, only loosely connected to the academic program). Some of these models are beginning to pop up (examples here, here, and here), but far more progress needs to be made in reforming clinical education to catch up with the reforms that happened years ago in the didactic curricula with the the transition to the DPT. These longer term internships would eventually morph into a post professional residency model in which PT students graduate and sit for licensure after 2 years, with the 3rd year internship/residency in an employed setting not unlike medical residency. This would be a huge boon to clinical education providers who no longer have to dance around complicated billing regulations (especially federal) regarding the provision of care by unlicensed personnel. On a related note, why virtually any of us provide clinical education in the current model speaks to the enormous benevolence and altruism among the PT community (because it makes absolutely no rational sense), and certainly one of our major strengths as profession.
Although the applicant pool to PT academic programs currently remains strong, we will undoubtedly see a tightening in the jobs market for PTs as the implications of increased federal regulations (discussed recently here) with respect to Medicare (ie, MPPR, G-codes, etc.) fully kick in over the next several years. There is little doubt, for example, that MPPR is a huge boon to PTAs, for example, who will soon be the provider of choice for virtually all Medicare patients (sorry Medicare patients…you won’t have much access to skilled PT). The collective implications of these reforms will cause prospective PT applicants to be faced with an increasingly difficult choice…take on an ever growing debt burden in a tightening job market and the resultant difficulty in paying back student loans versus simply choosing another profession. The good news is that crises bring out the best in entrepreneurs so the profession will adapt and overcome. The real question though is whether we will do so at a rapid enough pace to be on point (ie, patient access without referral, wellness, etc.) in a post health care reform environment or if we will stay relegated to hospital basements for the next 50 years as we have the last 50. What say you?