Clinical Education 2K16: The Best Bidder Gets the Spot

CSM was a great time to catch up with friends, network and gain new knowledge.  Interestingly, the new knowledge I had gained was one that I was not expecting to hear.  The word passing through the convention center was that some clinical sites were going to be charging PT schools for student placements.

At first I was pretty upset by the idea.  Why would a clinical site do this?  However, I hear the cry for help in the muck of payment for placement.  I know that taking on a student is a challenging endeavor for any clinical site.  Administrative time is needed for coordinating the rotation, CIs spend countless hours orienting students and working on CPIs only to have the student leave after 8-12 weeks.  I get it.  I’ve been there.  But isn’t this part of being a mentor for our DPT students?  Doesn’t the growth of a student trump some of the downsides of clinical education?

We can all agree that being a DCE is a challenging job as clinical sites are limited.  I would assume that bidding for clinical placements will only create more of a competitive market for sites, thus limiting where some schools can get these sites.  Isn’t it bad enough as it is now?  Charging for a clinical rotation is a slippery slope.  I would think that if a site has come to this, they are probably dealing with the wrong schools in the first place.  I can only think that these fees will only translate into tuition hikes that will only hurt our DPT students.  I think we should consider how clinical rotations are done, but payment for placement is not going to help.  If anything, we should be taking on more students.  We should be having them stay at our clinics longer.  We should be viewing the medical model of interning as one that can fit into the PT clinical education sphere.

Taking on a valuable student (not in the $$ sense) is a very rewarding experience, one that can actually enhance clinical care, productivity and customer service.  This valuable student could then become a valuable employee or resident, feeding into strong recruitment and retention.  Paying for a student will not equal greater value.  We are in an exciting time of PT education where innovation will disrupt the status quo, but I can’t help but think that payment for placement is heading in the right direction.

25 responses to “Clinical Education 2K16: The Best Bidder Gets the Spot

  1. As a company that takes several interns a year at all of our sites, this is extremely disappointing to hear. This reflects a common theme throughout physical therapy, “Let’s just throw money at it and it will fix itself.” Innovation is necessary, but I cannot see where this is innovative. I lean towards fewer but longer clinicals, 2 or 3:1 interns:CI ratio, guaranteed acceptance to site residency program, commitment to employment. Just shooting from the hip here.

    1. Mark Shepherd says:

      Richard- I am right there with you. I believe the longer clinical rotation is much more optimal as it gives the student more time to “get in the flow” of the clinic and their own rituals. I know this can’t be done every clinical rotation, but the final rotation would be optimal if longer than 12 weeks. This would lend exactly into what you suggest–residency and employment. What better way to interview someone than work with them for more than 90 days? Isn’t that a benefit that is priceless? Thanks for reading and posting!

  2. Jeff Moore says:

    Great post on an important topic Mark. In my heart I couldn’t agree more with everything you wrote, it’s my brain that is giving me pause. At this point in my career it isn’t a matter of making money, I don’t need an additional revenue stream from my students, it is a matter of fairness.

    When you look at Boissonault’s (1) work discussing the under preparation (and resultant future under utilization) of thrust joint manipulation in DPT programs the findings highlight the importance of clinical affiliations in teaching basic CAPTE required competencies. Quoted from the article, when faculty were asked “what would be the most beneficial way to increase their graduates’ preparation in joint manipulation (TJM)?…..the overwhelming response was increased emphasis on this type of technique in clinical affiliations”. Two things can fairly be said about TJM, first that it is challenging from a psychomotor perspective, and second that it is a valued evidence based intervention. You and I know from experience in teaching these techniques that plenty of physical therapists, even those with years of experience and additional post graduate training, continue to struggle in being consistently effective in using TJM. The value is evident in the market, entire professions have been built almost solely around this intervention and not without a fair degree of success. Finally it is a highly desired intervention, In a recent article by Bishop (2) 75% of patients felt having their “neck cracked” would be a highly effective treatment for their neck pain. So here we have the primary role of teaching a challenging, evidence based, and highly valued intervention being placed on the clinical instructors. This is quite an ask for no direct compensation. These past few years we have seen a great rise of interest in the “soft skills” revolving around a clinical encounter. As patient expectations and therapeutic alliance formation are shown to be an increasingly important predictor of outcomes we will need to increase our focus on developing these attributes of soon to be therapists. This area in particular will be challenging if not impossible to teach in a classroom, and thus again we will see an area of great importance resting on the shoulders of the clinical instructor.

    The list could go on into marketing and business, areas that only require 5 minutes of Twitter scrolling to realize are at the forefront of everyone’s mind and that again aren’t well covered in school but are expected to be “picked up” while out on internship if at all. The trend I am highlighting is that many core competencies, ones critical to new grads having a good shot at success following graduation, are resting on the clinical instructor’s performance. From personal experience in hiring and teaching I can say with confidence that there is a significant difference in the confidence and skill set of a new grad who had a dynamite orthopedic rotation compared to one who spent 8 weeks in a mill rocking modalities in between barking orders at support staff. Should a role this important in the development of the next generation of physical therapy doctors be entirely uncompensated? As the cost of school continues to rise at alarming rates, should none of the school’s ballooning profit be allocated to those developing and fine tuning these vital aspects of the educational process?

    Finally, perhaps the biggest hurdle our students and new grads are facing today is low paying jobs upon graduation. There is an unfortunate reality behind these small paychecks, namely that payment is declining and clinic owners are finding themselves less profitable than years past and simply aren’t able to shell out large salaries in that environment. Thus students are graduating with downright absurd student loan debt due to increasing cost of education and walking into jobs where their checks aren’t big enough to cover the payments because the clinics revenues are struggling. So the schools are raising prices but not paying the clinical instructors training these students, yet when the students graduate with the large debt due to the raised prices the clinical instructors that trained them can’t pay them enough because they don’t have the cash. It is a tough argument to say one reasonable solution wouldn’t be to direct some of the cash brought in by the tuition raises towards the clinical instructors and clinical sites to give them an additional revenue stream to offset decreasing payment and create funds to improve new graduate salaries. The universities aren’t feeling the squeeze from declining payment, the clinics are, and this just seems to be a common sense and fair solution in our current situation.

    Thanks for letting me chime in Mark, looking forward to your thoughts on these points!

    References:
    1. Boissonnault, W., Bryan, J. M., & Fox, K. J. (2004). Joint manipulation curricula in physical therapist professional degree programs. The Journal of Orthopaedic and Sports Physical Therapy, 34(4), 171–8; discussion 179–81.
    2. Bishop, M. D., Mintken, P. E., Bialosky, J. E., & Cleland, J. a. (2013). Patient expectations of benefit from interventions for neck pain and resulting influence on outcomes. The Journal of Orthopaedic and Sports Physical Therapy, 43(7), 457–65.

    1. Mark Shepherd says:

      Jeff- thanks for the solid response. This is exactly why I brought this up to the masses. I think there are both sides of the coin with payment for placement. Unfortunately, there are not many clinical directors, owners, etc. who think like you do and I fear that the payment from schools will get stuffed into the very people who have no vested interest or energy in training the students. I just get worried that this will only add to tuition for DPT school and only compound on the points you made about debt. Curious to hear your thoughts on this: do you see value in longer clinicals where a student could become an employee, a resident, with this model in mind?

      1. Jeff Moore says:

        Thanks Mark. Lengthening the clinical rotations seems a lot like doubling down in blackjack, it is something I would like to have the option to do (when I have ten or eleven against a showing bust card) but not something I would want to be forced into doing. Speaking candidly, the ability of students to integrate into a dynamic clinical environment while adding to the patient experience is WIDELY variable. Additionally there is the level of interest present as another variable. My heart sinks when I ask a student on day one of a ten week internship what area they want to practice in and they say “I am really passionate about neuro, I’ve already got a job set up for after I graduate”. I am thrilled this individual knows where they want to go but I can’t help but think it is going to be a long ten weeks with someone who doesn’t have a sincere passion for what I am teaching. So to answer your question, yes I want to double down on eleven, no I don’t want to split 6s. I would be really hesitant to sign up to mandatory long rotations where area of interest and quality of student couldn’t be well controlled, but may be interested if they could be.

        1. Mark Shepherd says:

          Great points, Jeff. This makes sense to me and if there was a long rotation, it would have to be for folks that know they want to go into that area of PT. Furthermore, there needs to be the option, that after a brief window of time, a student can switch to another rotation if they do not feel they match well with the clinic, or they change their mind about where they see themselves going. Again, this is my ivory tower thoughts and is easier said than done!
          With your example about the neuro student in your clinic–I get it and it is challenging at times and can be bored to some students when not seeing their ideal patients. However, if it is the right student, we might be able to make a huge effect on their practice when they graduate. I have a colleague who did a 6 mo. rotation with a FAAOMPT in the outpatient ortho setting who then went into acute care/ICU setting. She now uses manual therapy in this setting, breaking down barriers and stigmas about where this can be used. Again, takes the right minded student, but really makes for some cool growth! Thanks again for contributing to the discussion!

  3. Actually, this is common practice for medical schools and has been for as long as I remember. Not only are the clinicians paid for the placement, but the medical school faculty come on site several times and essentially fill out the paperwork required for the completion of the student’s time at that facility. By contrast, we are paid nothing, CMS won’t allow a student to bill for time with a patient, and the paperwork for that student takes at least 4 hours to complete ( more like 6 to 8 in most cases ).

    A further frustration is placement of students at POPTS sites. On the one hand, the faculty often have a weak position against POPTS but then they place the student at a site that undermines the ethics lesson. Faculty with a strong stance against POPTS manage to avoid these placements. In my experience ( 37 years ), most schools place students at POPTS practices.

    The paperwork demand for clinicians continues to increase, both from CMS and PT Schools. There are still 24 hours in a day. Medical Schools respected the time and talents of their ” adjunct faculty ” ( by the way, a title those of us in PT should receive, but rarely do ) by paying them and helping with the paperwork. For me, that is a great example of words of support being backed by action. We should be doing the same thing, and not just because of decreasing reimbursement and increasing documentation demands. Faculty should want to do this because talk is cheap and actions demonstrate to students what the faculty are REALLY teaching.

    When the faculty send mixed messages, then my work with that student is undermined, leaving me not as enriched by the experience!

    1. Mark Shepherd says:

      Brian- thanks for reading and commenting. I think you brought up some great points about POPTS–the issue seems that these clinics are willing to take students in with ease. We can only assume why this may be. I think the common response is that CIs feel that being compensated is something that should be highlighted in this model. I agree that this makes sense, but I am just concerned that at the end of the day, the CIs will not see this (or a very minimal amount). In my mind, as a clinic, I would prefer to work with a school that prepares the study well from a technical side and a “soft skills” side per Jeff’s comments above. I would also prefer a student who gets a longer clinical who would roll right into a residency spot or become an employee. To me this is more valuable as a practitioner and as a clinic owner as this addresses retention and hiring (hire slow). Building a strong relationship with a clinic trumps all monetary value in my mind.

      Thanks again for your comments.

  4. Jordan Reed says:

    Thank you for writing this post and providing the opportunity to generate positive discussion on a topic which is integral to the future of our profession.

    As a clinic director, charging PT programs for the students we rotate through our clinics on an annual basis is a thought that has been crossing my mind with increasing frequency, and based on the discussions at CSM, I am not alone. The idea of charging for student placement does create some personal angst as I am only where I am through the generosity of my clinical sites and instructors; however, there are very real costs associated with accepting and training PT students. These costs are incurred administratively as well as through lost revenue and decreased productivity. In addition, these costs are occurring in a climate of growing uncertainty surrounding payment for our services including alternative payment models and flat or declining payments, namely through MPPRs of 35-50% from both public and private payers in the state where I practice, which have been applied since 2011.

    On the educational side, the amount of PT programs, graduates, and educational costs continues to grow. According to CAPTE aggregate program data for years 2014-2015, the mean total costs of attendance for public, in state PT programs per student was at $55,997 and the mean total costs of private PT program attendance per student was $99,797. This is an increase of 20% and 17%, respectively, compared to 2011-2012 data. Meanwhile, the mean program operating and salary expense per student was $12,312 for public programs and $11,697 for private programs. Current information from CAPTE indicates that mean PT program length is 122.8 weeks with 87.4 weeks in didactic education (71%) and 35.6 weeks in clinical education (29%).

    Based on my experience and the information from CAPTE, our clinics are accepting some costs to provide students a portion their formal education while many programs are experiencing significant mean per student profit margins. For this reason, I do not accept the argument that clinics charging programs for student placement will automatically result in increased tuition costs for students. The CAPTE means indicate that programs can currently bear it, so any costs passed on to the students would be reflective of the institution’s decision to maintain its margins.

    I believe that this situation is an opportunity to strengthen PT clinical education, clinical practice, and elevate the profession. A clinic holding a PT program ransom by demanding a fee in exchange for a clinical site is an oversimplified solution that fails to address many of the factors at the root of this issue. However, PT programs should offer the clinics that are responsible for 29% of their students’ education some value for their time and efforts. Clinics working with PT programs to take steps towards providing a quality clinical education experience in exchange for value added benefits such as professional memberships, trainings, access to journals and clinical research opportunities, and free continuing education through the PT program faculty represents an alternative which is economically viable and clinically valuable for PT programs and clinics.

    1. Mark Shepherd says:

      Jordan-

      Thanks for taking the time to provide such an insightful response. I completely agree that clinical education needs to improve and align with your views on program cost and load on the clinical sites. This is why I think programs that are making programs more efficient to help reduce costs on the student are ideal. The other option is to consider improving the ratio of student to PT, as Richard mentioned earlier today. Given this, I understand that clinicians and clinic directors in the trenches are being stressed with reducing reimbursement, etc. This definitely doesn’t make things easier. I think you hit the nail on the head with the comment:

      “…through the PT program faculty represents an alternative which is economically viable and clinically valuable for PT programs and clinics.”

      This is right on point and I know several programs that do this. But as I have mentioned before, there should be the value set by the student themselves. I know when I have had a phenomenal student all the admin work, etc. is worth it. Having that person grow and come on as either a resident or employee is what a clinic wants. I think the value is that you get a great interview period for investing in your practice. We know that a happy employee makes a happy experience and this will pay off in the long run.

      Thanks again for your insightful post and reading the blog!

  5. Gerry Gordon says:

    I hear you Mark, but why do we as PT CI’s always have to be the ones to be charitable? The students are already paying for the credits they receive while on clinical rotation. The College/University does very little work, but still collects full tuition for the credits. The institution should allot some or most of that semesters tuition to the clinic that is hosting the student. This way the students tuition does not get increased, and PT CI’s will get a little more than just the warm feeling of knowing they are helping the future generations of Physical Therapy.

    1. Mark Shepherd says:

      Gerry- I see where you are coming from. I think it makes sense to have some type of strong partnership with an institution that provides some value to the PT CI beyond the “warm feeling of knowing they are helping future generations”. Like I mentioned in the blog, I just get worried that budgets are budgets and that these new charges for placement will only trickle down to the already high tuition for the DPT student. I feel for students that come out with outstanding amounts of debt to get sub-optimal salaries to meet their loan payments…I just don’t want something to contribute to this anymore than already exists. Thanks for your thoughts and discussion.

  6. Jason Steere says:

    Not sure where exactly my opinion lies here, but I would like to raise the question as to what this might do to raise the quality of the CI and that CI -student experience? Could we then raise the requirements for what it takes to be a CI? Pay for performance strategy maybe?

    1. Mark Shepherd says:

      Interesting. Tracking patient outcomes along with the CPI would be a novel way to look at complete performance on the students end. Also having a solid way for the student to rank the clinic in an easy format would be a good way to assess the CI. I know most places do this, but the questions asked are poor (i.e. years of experience, certs, etc.–none of which means you are a “good” practitioner).

      1. I think all of you make a lot of interesting points. I take a lot of students (sometimes 2-3:1). I believe that the Fellowship has prepared us for this (Jason, Mark and Jeff). I agree it should be something more than warm fuzzies of giving back, but at the same time, someone did it for all of us. That being said, does it infuriate me that people aren’t willing to take students because it takes too much time or whatever excuse they want to give? Yes!! But, I do agree that the school collecting tuition while the student is essentially not there, is similar to something, I’m sure, but don’t want to throw out extreme comparisons. Overall, I feel that we need to be part of a bigger picture of improving quality and elevating the profession. If that means more students, fine. If that means pay for performance when taking students, fine. If that means paying me for my time, that’s fine as well. The bottom line is that everything that we do, think and believe should be with the goal of professional elevation at all times. Okay, stepping off the soapbox.

        1. Mark Shepherd says:

          Great thought, Leigh. Overall, clinical education needs to change!

  7. Jeff Moore says:

    Jason, I think compensating individuals for work performed (versus expecting it on a voluntary basis) has a shot to increase quality. It is hard to compare to other industries as I am trying to think of fields/professions where someone has a role of routinely doing a good percentage of work on that volunteer basis, or for the “greater good”. I’d be curious if others can think of precedents that are out there.

  8. I don’t know that the quality needs to be improved. The expectations are already very high.

    Continuing to lean on the charity of PT’s to educate students in the clinic is no longer reasonable, and that is it’s own point. We don’t expect the faculty at PT or med schools to teach for free. Why is it the ” duty ” of clinicians to teach students without being compensated.

    As I stated in my previous post, MD’s are paid to take students and have the support of full time faculty at the school to fill out the paperwork. Why hasn’t this been the model for PT over the last 40 years? Do we not value the clinical model as additive to the classroom model? Do we not value our own profession enough to expect that PT’s should be compensated for their work? Where is the disconnect that has allowed a ” habit ” of giving away our time and talents to become the expectation?

    Insurance companies seem to share the feeling that PT isn’t valuable and therefore third party intermediaries can take care of that ” issue “. CMS seems to believe we aren’t valuable and therefore they don’t need to pay full price after the first 15 minutes and PT isn’t valuable enough to healthcare in general that we should be paid for continuing to care for a patient beyond some predetermined timeframe.

    We keep accepting these degrading premises as though we ” owe ” something, whether it’s more research to validate our profession or more charity to prove we are the ” good guys “. How is it that even within our profession, we seem to not value what we do enough to believe it is compensable? Maybe this is part of the reason outside parties don’t value us?

    1. Jeff Moore says:

      ↑↑↑↑↑ What Brian said!!!!

  9. Ryan Grella says:

    Aside from tradition we really shouldn’t even be having this discussion. There is no logical reason that a clinical instructor should not be compensated for their time, knowledge, and mentorship. The schools realized this a long time ago by giving instructors tokens such as CEUs, access to the university library, and tuition discounts. So now when someone asks for a dollar we are all supposed to be offended?

    Physicians taking medical students on pre-residency rotations are paid, and in the rare occurrences that the medical student’s school can’t cover the physician’s fees the student personally has to make up the difference. The medical students think this is perfectly acceptable, and there are no cries about “Giving Back”, “Charity”, and for the “Greater Good”. In fact when groups of medical students find out that physical therapist clinical instructors are not paid, they are often shocked and wonder why anyone would take students. I am not going to conclude that physicians and medical students are greedy capitalists and our profession somehow has it right.

    We need to value our own time and knowledge before we can even begin to attempt to get others to do the same.

    1. Mark Shepherd says:

      Ryan- thanks for reading and thanks for commenting. I think you raise some good points here. I don’t feel that a CI should not be compensated for their time and mentorship, however I am realistic that this money will most likely never find the people it should benefit most–the CI and/or the student. There definitely needs to be some value aside from “paying it forward” when taking on a student. I will be the first to say that we have the “nice genes” and tend to not stick up for what is deserved. But if schools are paying for placements, the placements should be giving quality mentorship—we need to see the outcomes. What are the student’s outcomes with patient care? What are the CI’s outcomes with patient care? What is the student’s perception of the CI’s ability to mentor? You see where I am going here. I think saying the compensation is needed is appropriate, we just need to make it work for the people who need it the most–the CI and student.

  10. Brad Tracy says:

    Hey all, this is really interesting discussion. I have been thinking about this topic over the last couple of days and while some of level of compensation to the clinical Instructor or clinical mentor may bring some level of accountability, I am not sure this alone is really enough to vastly improve the quality of clinical education. While I have limited experience in academia, the workings of a PT program, and the complexities involved, it would seem to me that the very intent and purpose of a clinical degree ( the DPT) is preparation for clinical practice. The clinical experience, internship, or rotation (or whatever is the current terminology) would seem to be such a key component. As I look back, almost 12 years now, the quality of such experience for me was very hit or miss and dependent on the “luck of the draw.” While my educational institution handled some of the administrative tasks around provision of the clinical assignment, handled some paper work, and some delivery of some records/documents that seemed to be the extent of the involvement and my clinical education (of which would serve the basis for entry into practice) was entrusted with the good faith and hope that my “luck of the draw” would serve me well. (Yes, I do realize the much preparation and and effort on the part of the academic organization and faculty was spent on preparing me, but still the environment of which I would blend my classroom learning with the clinical world was the “luck of the draw) Based on the discussion in this forum, this would would seem to be still the same general state with regard to the structure of clinical education. So, I think the structure of the clinical experience requires consideration, beyond just financial discussions. The other problem is that ideally there should be carryover from the classroom to the clinic, and from clinic to the classroom and I wonder if this should really be the area of focus. The solution would seem to exist around collaboration between academic organizations and the clinical organizations. I suppose I envision a key network of clinical sites with clinicians that are also “clinical faculty” who are connected to the academic organizations. Similar to “heath care silos”, we have currently would seem to have “silos” with respect to clinical education with the training of physical therapists. The PT program on one end, the clinical site/CI on the other end, and the student stuck in the middle. .The ends of which do not really operate within a reciprocal or truly collaborative nature to serve any party very well.. Additionally, what level of training is really provided to the average clinical instructor to be really a clinical instructor? And what resources exist to train and provide the clinical instructor with the tools to do an adequate job? So, as practicing clinician…..Sure, pay me to be a clinical instructor but also involve me in the academic problem as “clinical faculty” Alternatively, provide compensation to my employer to allow the time and work together to provide the resources. But, make it truly collaborative and reciprocal process. Imagine the potential. For clinical instructors (at least for me) my motivation is not only to “pay back” the profession, but also to grow myself, perhaps open professional doors, be involved in clinical research, grooming to teach. Imagine the potential for collaboration and true reciprocal networks between PT programs/academia and clinical sites/clinical organizations. Clinical sites and clinical organizations face challenges of which the “brain power” and intellectual resources could be appreciated. A demand exists for exceptionally trained physical therapists. The focus is perhaps more important on improvement of the structure of clinical education within the mindset of reciprocal collaboration with an emphasis on quality and value. With that in mind, the finances involved may just work themselves out. Is such a structure an overly optimistic view?

    1. Mark Shepherd says:

      Brad- Thanks for reading and posting. This response is excellent! I love the idea of the clinical faculty–helps establish consistent relationship between CI and school.

  11. Marisa says:

    Hi everyone, speaking from the perspective of a student, I have mixed feelings on this as I consider the logistics and operational restrictions that go into placement of students. I’m on the OT side of things, but the fieldwork requirements are similar. I was often acutely aware of the burden that my placement at a facility caused. I went into school knowing exactly how I wanted to use OT and what types of organizations I would likely be looking for in the future – none of it is ‘traditional’. I was forced into placements in settings where YES, I learned a ton and enjoyed my time there, but I had no intention of ever going to work for them! I have seen the look of dissappointment time and again, as I’ve responded to questions about returning to work for a placement site. The current system does a disservice to the student who has a personal trajectory & the company who is hoping to find quality employees.

    I also had horrible placements where students were treated as if they were a huge a burden. It is always difficult to tell who is ‘right’ in conflicts that arise on fieldwork – is it the student being unprepared, unrealistic expectations of the site, or personality conflict? Either way, students often have no say in how things go down and problems are often brushed under the rug. Someone above mentioned being able to review or rate sites, and if I was paying for mentorship, I would also like to be able to see that feedback from others. A simple business description does nothing to help someone determine if they can fit into the leadership style that an organization adopts.

    I personally would LOVE to pay a site instead of my school for my experience with them. I’d like to see a business transaction occur – I could view a list of things that I would be exposed to and skills I would aquire while there…I would like to see potential profiles of CIs with their specialties, interests, and experience and be able to match based on interest and personality through an interview. I think that CI’s deserve to spend their time mentoring someone who they feel is dedicated and prepared, and would fit into the organizational workings and/or client requirements.

    I paid over $5,000 for training and mentorship on skills that I knew I wanted to have when I entered the workforce which were not available to me through fieldwork. By ‘buying’ mentorship, I felt that I had the right and opportunity to have my CI’s dedicated time throughout the experience, and that person wanted/had chosen to help ensure I had reliable practice skills when I left the facility. If I could have done this for my fieldwork placements, I feel that I would have left school feeling prepared for my chosen path without wasting the time of companies who offered me jobs they knew I wasn’t going to take. My choice to buy mentorship was the #1 best choice I made throughout the entire process of getting my doctorate.

    1. Mark Shepherd says:

      Thanks for commenting, Marisa. I find it interesting to read/hear what other students/professionals have to say about this topic. We can see that the struggle is real beyond PT. I loved your point about employers being disappointed about becoming an employee. I think there is a ton of value in being an intern and transitioning to employee and a matching style system, at least for the final internship, would really help drive intent when placing a student for their final affil. It is difficult to do this for the first rotation, as many students are just getting into the clinic for the first time (beyond being a tech) and may not know where they see themselves working.
      As you allude to, mentorship is key and many new graduates value this very much. This again plays into the value a clinical site can bring–structured mentorship during the internship and beyond. I see a matching process as the future of clinical education, we just need the sites where students go to be of quality and willing to be part of the process.

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