Residency Training in PT – Are We Prepared for the Future?

Residency training in PT isn’t anything new in our profession.  There are well over 150 programs out there and a number of applicants that are looking to progress their professional careers after PT school.  Last year, there was a lot of chatter on the idea behind mandatory residencies (read here, here, and here).  In late 2017, the APTA Board of Directors modified task force recommendations based on stakeholder feedback and voted to pass these updated recommendations on to another task force (Education Leadership Partnership (ELP)) for consideration and potential action.

It is great to see that there is much talk in our profession now on best practice in PT education (both didactic and clinical) as well as post professional training.  The APTA is clearly locked into the idea that residency training will become the norm for most new graduates some time in the future.  I believe that this day will soon come, whether mandatory or not, but this thought has me thinking:

Are we prepared for this?

Fruze et al published an outstanding article in 2016 regarding Residency and Fellowship Education: Reflections on the Past, Present, and Future.  The article goes into the current state (at least in 2016) of residency and fellowship education and called out several aspects for the future of post-professional training.  The authors state that there were 540 individuals admitted into a residency program in 2013 with over 1,400 applicants applying.

This means that less than 50% of applicants get a resident position.  I have a hard time believing that over half of these applicants were not qualified.  In fact, I worked for a health system that interviewed over 20 applicants for 3 residency spots – most of the time each one had the drive, professionalism and focus to be a successful resident.

The issue I see here is that we have a major bottle neck in the entry-level to resident transition point.  Whether people want to admit it or not, 2 year DPT programs are here and here to stay.  This will provide the opportunity for more graduates to apply for residencies given that PT school debt won’t be as catastrophic (as compared to 3 years of PT school plus a residency).  With more applicants, will we have the capacity to take them?

The only way this can happen is if clinics, health systems, etc. start thinking differently.  We need to start looking to the medical model where the attending physician works with several physician fellows, who work and train several physician residents, who work and train several physician interns.

The key factor?

Each person in the “hierarchy” is training more than one other person.

We have to get away from this one-on-one training model that will never meet the needs of resident applicants the future holds.  This should change – this needs to change.

Thoughts?

@ShepDPT

4 responses to “Residency Training in PT – Are We Prepared for the Future?

  1. Ron Masri says:

    Mark
    What a great write up. I so agree. We have transitioned to a 2 to 1 model here at our company. We do need folks at the clinic level step up and act on this. The 1 on 1 model is not sustainable esp with the influx of new residency applicants and more and more programs possibly going to a 2yr program as you mentioned. From a private practitioner point of view you can increase productivity with this model with out sacrificing quality of care and can be a win for both parties — the residents and the clinics. I think we just have to step out of our comfort zone a bit and with the right communication, mutual understanding, expectations and correct structure this 2 to one or 3 one model can work.
    Ron Masri

    1. Mark Shepherd says:

      Funny you commented, Ron. I was thinking how your model is pushing this change. Thanks for living the future in the present.

  2. Cody Thompson says:

    Mark, you and Ron make some great points. And I totally agree. I see things from a slightly different angle, though I believe it supports both of you stating the need for something other than the 1 on 1 model. I’m going to argue that this is at least partially a gender issue. What I mean by that is this: PT is similar to Nursing in that such a huge portion of licensed professionals in the US are Female (70.4% of PTs, per more than one website). So the pool of available mentors is (or is potentially) reduced by a workforce that is PRN, part-time, unavailable due to pregnancy/kids, etc. Hospitals struggle with staffing nurses due to all that comes with having a largely female profession, such as being a female/mother. And while obviously not all women PTs/PTAs are as “fluid” in their careers as others, I do believe that having such a large portion of the profession who is unavailable to be a residency mentor is a huge issue. I just have no idea how to fix it…..That being said, to your point, the 1 on 1 model does need to change.

  3. Brian P. D'Orazio PT, DPT, MS, OCS says:

    Mark,

    I agree with the premise that we need residency training and it should fit a model more consistent with MD training. This concept fits in well with the blog by Stephen McDavitt a few weeks ago in which an erudite presentation of educational hierarchy created an unassailable argument for the role of PTA’s and the fine education of PT’s. That argument, however, meets the unassailable reality of an inadequate financial model. Reducing educational costs is a small response to the growing chasm between educational theory and business/practice reality. The financial assault on our profession continues to dilute patient care approaches and limits business models to managing loss. Ironically, S. McDavitt’s blog begins with the heading ” What is the bottom line in the issue?”. Well, the bottom line is consistently red, and that drives decision making more than educational hierarchy and erudite algorithms (as valid as they may be). The bottom line is so tight that there isn’t room for “what should be”, only “What will keep the doors open?”.

    Brian

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