Food For Thought: Should DPT school be more competitive in the future?

[TheOx777]

I was sitting back and pondering, as usual. I began to wonder whether or not DPT school should become more competitive in the future. In light of the fact that all of the B.S. programs have been phased out and the remaining M.S. programs will be phased out in several years time, the natural trajectory of the profession is that is becoming more competitive to matriculate into Physical Therapy programs around the country. What if another layer of competitiveness was added? Would this shed even greater light on the need for physical therapist as clinicians and independent practitioners.

I am beginning to see more post DPT residency programs pop up around the country. I have also heard practicing PTs(on this forum) and at my clinical observations state that many students are still not as prepared to practice as they should be once matriculation is completed. What if the DPT was 4 years with the last 1.5-2 years being a residency that was split up in the 8 specialty areas that a PT can practice in?

It's clear that "upper level" healthcare professions are at an advantage when it comes to power and prestige due to the fact that these programs are more competitive to get into and matriculate through. This is also one of the chief reasons why a MD/DO/DDS/DMD/DVM/PharmD would command a larger salary than the typical DPT. There are many logistics to work out, but it was just food for thought. What do you guys think?

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[jbizzle]

I am beginning to see more post DPT residency programs pop up around the country. I have also heard practicing PTs(on this forum) and at my clinical observations state that many students are still not as prepared to practice as they should be once matriculation is completed. What if the DPT was 4 years with the last 1.5-2 years being a residency that was split up in the 8 specialty areas that a PT can practice in? ....................What do you guys think?

I dont think this would make it more competetive to get into a program...would it? You can still get into PT school. Residency would be the competitive aspect of it. Which means the competitiveness of your classmates will turn up as well, and will leave you out to dry when trying to study together because they want to get better grades than you so they get into a residency program. If CAPTE/APTA makes it a requirement then it will become really competitive because theres only a handfull of specialties to get a residency in.

The director at one of my interviews believes that PT will eventually become a 4 year program with that last year being a residency like you said. He projected it will be in about 7-10 years. But this would be a guaranteed residency...i think.

But speaking of competitiveness, now that I have been accepted, maybe add on an Physical Therapy entrance exam similar to what med, pharm students have to take (MCAT, etc.) instead of the GRE?????

 

[TheOx777]

Jbizzle,

Good point about it being more competitive to "get into". An entrance exam would more than likely be similar to the MCAT, PCAT or DAT. If that were the case, then Organic Chemistry I and/or II would have to become prerequisites for DPT programs. That would certainly make it more competitive. I really like the idea of some sort of residency, though. The more experience, the better in my opinion. Seeing that the typical programs seem to average 32-40 weeks of clinical rotations, adding an extra 20-40 weeks seems like a good idea. After that amount of time, knowing whether you want to be a generalist, OCS, NCS, PCS, etc would probably be a much easier choice.

 

[adh28]

As an upcoming student getting ready to apply to PT school this next year I am very surprised that there is no PT entrance exam and instead just the GRE which it seems like most Arts, Humanities, and Social Science grad programs only require. It would be a great idea for a residency-like part of graduate school for PT because it feels like I am basing my choices of graduate schools I want to apply to based on the amount on clinical internships that are a part of the different programs. That is what worries me as I look at St. Augustine's program compared to others is that it is a shorter program that must mean the clinical time is shorter? I am assuming that all schools have a pretty general guideline of class time though. I hope to see PT schools pick up a residency period requirement though because it does indeed seem like practicing therapists that I have done observation hours have the most concern regarding the amount of clinical time that new graduates have experienced before becoming full on practitioners.

 

[TheOx777]

As an upcoming student getting ready to apply to PT school this next year I am very surprised that there is no PT entrance exam and instead just the GRE which it seems like most Arts, Humanities, and Social Science grad programs only require. It would be a great idea for a residency-like part of graduate school for PT because it feels like I am basing my choices of graduate schools I want to apply to based on the amount on clinical internships that are a part of the different programs. That is what worries me as I look at St. Augustine's program compared to others is that it is a shorter program that must mean the clinical time is shorter? I am assuming that all schools have a pretty general guideline of class time though. I hope to see PT schools pick up a residency period requirement though because it does indeed seem like practicing therapists that I have done observation hours have the most concern regarding the amount of clinical time that new graduates have experienced before becoming full on practitioners.

You sound very aware of what you are getting yourself into. I hardly know anything about St. Augustine's program. How many weeks of clinical rotations does a student do there? I have seen a lot of variability among programs regarding class time. Keep in mind that even a 3-5 hour swing per week could potentially make a big difference. The more I think about it, it just makes sense to give students as much clinical experience as possible(and probably even more than they care for) Why get out of 7+ years of school, enter the workforce, and still feel that you are not fundamentally prepared to practice your profession at the highest level. There will always be much to learn, especially for those who want to specialize. There will also be mountains of research that you would need to keep your practices current. That said, the more knowledge and experience the better!

 

[callmecrazy]

Some programs (I'm assuming Pitt isn't the only one) already have a year long internship at the end of the DPT program that could parallel a residency in many ways. My class will finish coursework in April and then we all go separate ways to complete a full-time year-long internship before graduating a year later. We had to interview with our desired sites, and spots in various specialties were limited. This extended placement was a major plus when I was considering schools.

That being said, I would be in favor of a more consistent clinical education plan being implemented across the board. However, I think the focus should be on appropriate preparation rather than competitiveness. I also don't think it would require an extension in the length of most programs, just a restructuring.

 

[MinnDasota]

I believe way back when during the history of transitioning to the DPT, the APTA pondered the requirement of a residency (and to follow the traditional medical model). Obviously, it didn't pan out.

That said, adding a residency wouldn't make admission into PT school itself more competitive. A residency is reserved for those already licensed as a PT and would be separate from PT school. If it was required, this post grad clinical experience would be where most of the competition would lie.

Currently, because of the lack of residencies out there, it is very very competitive to get in. It is also very tough for a practice to create and provide a residency as those teaching the residency has to be board certified in that specialty. There are just not enough residencies or board certified specialists to make it a requirement for PT school at this time. I like the idea set out by the OP to somehow make it part of a PT grad's clinical experience as it adds additional mentoring and preparation (while getting paid!). It may also give us more credibility to those in other health care professions who argue against a doctorate in physical therapy due to the lack of a residency.

Residencies are made for specialist training. Splitting the residencies by the 8 specialties in 1-1.5 years is too short for specialist training. However, adding maybe adding 1 year of residency in a PTs preferred specialty would be more realistic.

I'm all ears for improving and lengthening the PT curriculum, but I can't imagine a lot of people would be thrilled to have to pay another year's tuition! If only our salaries were not at the whim of insurance companies reimbursements...

 

[TheOx777]

MinnDaSota,

I'm loving all of the feedback. Pros/Cons list is exactly what I wanted to get the ball rolling. I'm assuming you are a PT resident. If so, what do hope to specialize in? If not, then what are you a resident of? I wonder if adding some sort of incentive to specialize would increase the number of specialists, thus cracking the door open for a possible increase in residencies?

 

[johncronejr]

I asked a PT that I observed under if she felt the DPT grads were much better suited as PT's than the previous MSPT's. She said flatly "No". We talked about this a bit and it seems that the majority of the extra year is clinical time. Now it would seem that more clinical time makes a better PT, but where is the cutoff in how much more clinical time makes a much better graduate? There is little doubt that there are many MSPT's and BSPT's out there who can work circles around new DPT's. They have learned much over the years through work experience.

Now my take, and what I told her, is this: I actually wish that they had left it as a MSPT. That would lessen the costs and time needed to get to work. Then I could spend that next year getting more skill in the clinic WHILE GETTING PAID.

 

[TheOx777]

John,

You make a good point. I agree that more time in clinical rotation during DPT school does not equate to being a better PT, but it should. One would think that the more experience a person gets with a variety of cases would culminate into that person being a better clinician than a counterpart who did not. Like you said, this is not always the case. I often wonder if this is a result of PTs not being able to "use" everything that is learned in school. Makes you wonder why an entry level DPT is not considerably ahead of MSPTs when they were entry level years ago.

Also , I know that the APTA specifically states that changing PT into a "doctoring" profession would hopefully be tied to billing rights. So once again, it also goes back to the all mighty dollar. I would argue that it should be tied to money, at least to some degree. There would need to be some serious restructuring of the "system" in order to add the significant amount of clinical experience I was referring to earlier. It would have to be agreed upon by the schools, the thousands of clinical sites around the country, federal government official, etc. Thus, I imagine that it would take the 7-10 years that jbizzle is referring to.

 

[summerX]

I don't think that the DPT programs need to be longer than 3 years to adequately train physical therapists. There are probably other possible ways to improve patient care without adding more time (increasing debt and time in school). However, I think that an area that PT's need to improve on is wound care. I have only been practicing a short time, but I have seen numerous orders for PTs to do different types of wound care and then see the PTs go and ask the wound care nurse/specialist to do it. If we can't step up and provide care within the scope of practice that we do have, then our scope will become even less. So I think actual hands on practice with wound care would be beneficial. Also perhaps maybe there could be more hands on classes offered as undergraduates. I feel like there were alot of classes I took as an undergraduate that didn't improve my patient care at all (that's also true for a couple classes I took in grad school). So if more of PT school were taught as undergrads, then graduate school could be used to be more competent in our entire scope of practice (i.e. wound care, experience in all different specialties of PT).

 

[jbizzle]

I don't think that the DPT programs need to be longer than 3 years to adequately train physical therapists. There are probably other possible ways to improve patient care without adding more time (increasing debt and time in school). However, I think that an area that PT's need to improve on is wound care. I have only been practicing a short time, but I have seen numerous orders for PTs to do different types of wound care and then see the PTs go and ask the wound care nurse/specialist to do it. If we can't step up and provide care within the scope of practice that we do have, then our scope will become even less. So I think actual hands on practice with wound care would be beneficial. Also perhaps maybe there could be more hands on classes offered as undergraduates. I feel like there were alot of classes I took as an undergraduate that didn't improve my patient care at all (that's also true for a couple classes I took in grad school). So if more of PT school were taught as undergrads, then graduate school could be used to be more competent in our entire scope of practice (i.e. wound care, experience in all different specialties of PT).

Oh wow!!! I only got to observe wound care for 1 hour when volunteering and from that point on I wanted to be in the acute setting because of the wound care aspect of PT. Too bad there really isn't a specialization for it, but I can get a wound care certificate. Hopefully wound care specialization will be established soon. I hope I get enough training for this wherever I go to school/clinicals

And schools do have some requirements with what you pointed out. (i.e. volunteer hours in different settings-so they get experience in different settings/specialties). Summerx, how long have you been a PT again? I believe i've PMed you before but I keep forgetting.

 

[MinnDasota]

Wound care is very specialized and definitely should be taught more in the PT curriculum. It's one of those niches in PT that we need to hold onto more firmly before we lose it to other professions! That said, wound care is mainly seen within the hospital setting so those of us in outpatient rarely have to deal with this.

I'm not sold on the idea of teaching PT classes in undergrad. It is in the PT curriculum for a reason, probably for accreditation. There are a ton of classes that can be taught in the PT curriculum, however, it's really up to CAPTE to make it required. I believe in the clinical component and believe the more the better (especially as CI's can vary greatly). Some are just horrible teachers...or are just not up to date with recent evidence.

If there is added clinical experience to the PT curriculum, I feel as if it should be for specialization...which is why I like the idea of residency. Residencies are much more rigorous and focused than clinicals in PT school. My current practice is part of an orthopedic residency program and the resident is working her butt off in the clinic, doing research, attending conferences, etc. She gets no sleep. When I was in PT school, my final clinical was in a facility with a sports residency. The sports residents worked their butts off too...Made what I had to do as a student so trivial.

Ox, I've been too lazy to update my info thus the resident tag. I was accepted into a sports residency in 2009 but was not able to attend after accepting. I will change it someday.

 

[mtm34]

I believe the major reason for the transition to a DPT (aside from $) is the fact that PT's are going to have to do more in the future (which has to do with $). But regardless, my patients constantly complain of having to wait 2-3 weeks to get an appt with their orthopod then go and wait in their office for 2 hours for a 10 minute appt.
The way I see it (and research backs this up) is that PCP's are not good enough at Dx musculoskeletal disorders properly and orthopedic surgeons need to spend their time with people who need surgery. The DPT along with direct access are designed to allow patients to receive timely and effective care.
The demand for PT in the future is well understood but I have seen several job projection rankings put PTA as the #1 job for growth in the future! Around 45-50% growth! What this means is that DPT's will become more Diagnosticians and less of technicians. In simpler terms, PT's will Dx a pt., set up a plan of care and oversee it while the PTA/tech carry out treatment.
But in all honestly no one really knows...

 

[hefe]

Looking at other models I don't believe a residency should be a requirement. Instead, follow the more clinically intensive models stronger programs tend to use. Look at dentistry, they work with their hands and do important operations on patients, even in general practice. Yet, don't require residency to practice. It's only those very specialized dental surgeons, or lucrative specializations that require a residency. Residencies should be for those who want a specific specialization in an area requiring it and with enough need.

PT has it's specializations, but none of them are as lucrative as those in dentistry. Most places couldn't afford a mandated residency other than large PT institutions, businesses, and state hospitals. Otherwise, where's the funding? You can only work/learn/be paid so much in the time frame. Taking on more tuition or fee cost to the student is impractical as well.

It's naiive to simply make the assumption longer schooling = greater compensation. Perhaps, there is room to grow in finances, but it is not purely by showing wow we take lots of classes and are in school 8 years. What does work is effectively demonstrating to the public and primarily to policy makers the importance of PT and its benefits to a variety of patients in rehabilitation (with well trained clinicians). Learning should be something that is done while in school, but also as you increase your knowledge through consistent continuing education as you practice. Honestly, 3 years at a solid program should be plenty to get started in the PT world.

Another thing, the APTA should be by and large mindful of pumping out too many/ grads to the market in the next 10-20 years. The demand is strong now, but the profession is also growing as well. A large focus should be on making it's current programs as strong or stronger than they are currently.

Part of what's really hurting pharmacy right now is a host of new schools cropping up and this inflation of the market with new and arguably weakly qualified programs. The market does not support it, despite 5-10 years ago it was supposedly a "growing profession." Law (JD) is a worse example of this idea. 'Diploma Mill' education do nothing but hurt professions, line educators pockets, and create false hopes for students who are then sacked with debt and no job. A professional organization that is mindful of those it represents, seeing these scenarios in recent years and the real problems it creates. Too much and too little slots can either hurt in the long run.

 

[markelmarcel]

But speaking of competitiveness, now that I have been accepted, maybe add on an Physical Therapy entrance exam similar to what med, pharm students have to take (MCAT, etc.) instead of the GRE?????

That would suck, considering I don't have a related Bachelor's degree, I probably wouldn't be able to pass that test, haha.

 

[goyo1010]

But speaking of competitiveness, now that I have been accepted, maybe add on an Physical Therapy entrance exam similar to what med, pharm students have to take (MCAT, etc.) instead of the GRE?????

Yeah, I think a good first step is to formulate a proper entrance exam for physical therapy. The GRE is good to some extent, most specifically the verbal and AW parts; however, it's not that applicable.

As for hefe's concerns of diploma mills, I believe the APTA has a way of making sure this does not happen, with their accreditation of schools and such to let students and people know that these accredited schools meet certain quality standards. The medical profession saw diploma mills run amok before mid 19th century. Fortunately, tighter regulation by the government and the AMA helped to rid the U.S. of these diploma mills for MDs.

 

[jbizzle]

That would suck, considering I don't have a related Bachelor's degree, I probably wouldn't be able to pass that test, haha.

Keeping in line with the "competitiveness" theme of the post. Pre-reqs should take care of passing an entrance exam for PT. That's just like the other post I've seen around SDN where people say that degree's should matter to an extent; as long as you have taken the pre-reqs, it doesn't matter what degree you earned right. maybe it does matter then. So then would that make it more difficult for non science majors to get accepted. With this said, markel, you would do fine on an entrance exam with a 3.8 pre-req.

 

[Mergyman]

I feel a 4 year DPT program will drive students away from the profession. Something does not feel right to me about 8 Years of undergrad resulting in an $80K year job with limited upward mobility anbd potential salary increases. Not to mentiion the additional cost of another year of school as opposed to current DPT programs.

 

[TheOx777]

All great points being made. Hefe, I think what you said about DPT programs "pumping" and/or "milling" out too many graduates by 2020 is what I was getting at, at least in part. Let's say no more schooling was added and no residency was mandatory, then I, too, believe that the quality of schooling and clinical experience should be a lot better for some DPT schools.

Case in point, I just left a Mayo Clinic interview. That freaking program is........ How it doesn't get more recognition is beyond comprehension, but the only "downer" for a lot of ppl is that located in Rochester, MN. Also, they only accept 28 ppl . Here you have a minimum of 53 weeks of clinical internships, and that doesn't include the part-time clinical and service work you do during the school year. So in this particular instance, you have a program that mandates 15-20 weeks more clinical experience than the average DPT program. This type of setup is at least a start in the right direction.

 

[markelmarcel]

So in this particular instance, you have a program that mandates 15-20 weeks more clinical experience than the average DPT program. This type of setup is at least a start in the right direction.

That's amazing!!

 

[hefe]

All great points being made. Hefe, I think what you said about DPT programs "pumping" and/or "milling" out too many graduates by 2020 is what I was getting at, at least in part. Let's say no more schooling was added and no residency was mandatory, then I, too, believe that the quality of schooling and clinical experience should be a lot better for some DPT schools.

Case in point, I just left a Mayo Clinic interview. That freaking program is........ How it doesn't get more recognition is beyond comprehension, but the only "downer" for a lot of ppl is that located in Rochester, MN. Also, they only accept 28 ppl . Here you have a minimum of 53 weeks of clinical internships, and that doesn't include the part-time clinical and service work you do during the school year. So in this particular instance, you have a program that mandates 15-20 weeks more clinical experience than the average DPT program. This type of setup is at least a start in the right direction.

Thanks for the report about them, another program I thought hard about applying. Good luck to you.

I think in June after this is all said and done I'm going to start an 'under the radar' list of PT schools from my SDN.