Will Residency and Fellowship Programs Survive?

The Problem

As many of you may know, there have been several changes in the policies that ABPTRFE have put into place over the past year.  I, along with many other leaders within the post-professional world, have recently been outspoken on some of these issues.  In summary, ABPTRE now has the following policies:

  • Item 13.4 “Change in Curriculum” – requires a physical site visit for every additional participant practice site after the addition of a second new practice site in one calendar year.
  • 4.2.4  Admission Criteria: requiring residency training, or American Board of Physical Therapy Specialties (ABPTS) specialist certification– i.e. the elimination of the “Skills Track” as the third path for admission to a fellowship program.

Both of these policies will threaten the future of post-professional residency and fellowship programs.  They also cause divisiveness, disruption, and increased administrative burden in these clinical training programs.  Rigorous standards should be implemented with transparency and integrity, and which focus on policies that really matter for high-quality education and training without increasing administrative burdens.  Dr. Sharon Dunn has always stated: “We are better together”.  However, ABPTRFE’s actions are not transparent or collaborative, nor do they support our President’s initiative.

 

Confusion and Frustration

Here are several points that support why many programs are threatened by these policies and the lack of rationale behind the implementation of these policies:

  • The 20 opposed OMPT Fellowship programs estimate the need to add a total of 232 participant sites in 2019, costing a total of approximately $111,000 in total for physical site visits alone.  These are costs that are not within current budgets.
  • Increased costs associated with this policy may unfairly discriminate against subsets of the physical therapist population whose families are already challenged by paying for their advanced education.
  • Clinics and clinicians already fall under several layers of state and federal oversight; therefore it is unclear what will be gained by the additional investigation at these ABPTRFE directed physical site visits that is not already overseen by other agencies or covered through current annual and monthly substantive change reporting.
  • Site visits will be required for sites where FiTs are only conducting clinical care (no 1:1 mentorship hours).  This is a disruption to the clinicians and the patients at each site for no clear reason.  CAPTE does not have this requirement, and the responsibility of obtaining quality clinical sites and faculty is within the purview of the programs, and CAPTE has a much higher risk. CAPTE oversees the actual educational processes for licensing PTs. Oversight of participant sites for licensed professionals should be the responsibility of the Program Directors and Program Coordinators.
  • Requiring residency training or American Board of Physical Therapy Specialties (ABPTS) specialist certification greatly restricts the overall pool of applicants available for admission to fellowships, and removes the ability for programs to admit those who have gained sufficient skills necessary for successful matriculation through rigorous fellowship programs based off individual programs’ alternate criteria.
  • 3.6.6 in the 2018 ABPTRFE Quality Standards (Part III) document regarding fellow mentor qualifications states that a fellow mentor can “possess significant and current experience (minimum of 2 years) in the subspecialty area.”  Why can a fellow mentor, someone who does not need an ABPTS certification or hold FAAOMPT status, provide clinical mentorship for fellows-in-training yet these same individuals are not qualified to enter a fellowship? This contradicts the admissions criteria.
  • There is no data-informed rationale for requiring board certification prior to fellowship training.  Countless times ABPTRFE was asked to present data that showed that those holding ABPTS specialist qualifications outperformed or were more qualified than a clinician who has taken continuing education courses in manual therapy and had proven their ability to provide patient care at the same level as a resident graduate or an individual that passed a multiple-choice board certification test. ABPTRFE/APTA’s national data is not representative of geographical needs to trigger a change in the admission criteria for a fellowship program. This is true for OMPT, cardiovascular and pulmonary, hand, and sports fellowship programs.

 

Going Forward…

It is known that ABPTRFE does not want to stunt the growth of advanced training within the field of PT or work to shutter the doors of programs that have been running for years.  What we ask is that they take these concerns seriously and work to eliminate these barriers as soon as possible.  I can only hope that there will be fruitful discussions during CSM to put a better foot forward, otherwise programs will be looking to shut their doors.

@ShepDPT

3 responses to “Will Residency and Fellowship Programs Survive?

  1. Joe Farrell says:

    Mark: you have articulated major concerns relating to ABPTRFE issues which are chronic over the years. Hopefully at CSM we can rectify this situation.

  2. @physicaltherapy says:

    Very typical of accrediting organizations-out of touch with times and groupthink reflexively causes over-regulation under the misguided idea that their onsite visits, increased cost, enhanced requirements will actually elevate residencies and fellowship when in fact the opposite occurs and these process hoops and ladders stifle access, drive costs up, and have zero impact on quality. Many of these are laughable but the most absurd is the elimination of individual program’s alternative and compelling ABPTS certification first. This another classic violation of conflict of interest in the form of trying to enhance non dues revenue for APTA who benefit financially from ABPTS certification. My recommendation is that the first order of business is to unhinge academic credentialing and board certification from APTA which is by far in the best interests of the profession. This is somewhat similar predicament to Foundation for Physical Therapy Research which has grown and is far more respected apart from APTA yet understandably strong collaboration exists between Foundation and APTA. As long as APTA owns board certification and R/F accreditation, expect this to be cyclical. An independent 3rd party is a must for clinical programs and board certification-something every other medical board understands. The public deserves it as well.

  3. Jamie Lee says:

    Mark,

    I really appreciated this article regarding this issue. I also enjoyed listening to your conversation with Brandon over facebook live. I learned a couple new things that I hadn’t known previously. I’ll be honest: I initially agreed with ABPTRFE’s fellowship admission requirement changes. However, after thoroughly reviewing the pros and cons, particularly with the cost of education, it would be in the best interest of the profession to not go the current route. It’s great to see the fellowship programs banding together to get their voice heard. Hopefully this will raise the alarm and the decision will be redacted. Best wishes.

    -Jamie Lee, DPT, MSN, OCS, CNL, CSCS

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