New grad bashing

[jesspt]

There is research showing that experienced BSPT's have no better outcomes than DPT's with little experience. If we assume that individual PT's improve in their craft over time/experience then how would explain the equal outcomes? If the schooling is the same or close to the same then shouldn't more experienced PT's with less education have better outcomes? Is it possible that more and better quality education in physical therapy compared to 1980 training levels could also improve outcomes (like experience does) and thus make outcomes amongst novice/higher educated PT and more experienced/less educated PT's close to the same?

Add experience to better education and over time you get better outcomes. Compare the average 2015 DPT grad to the average 2005 grad or 1995 grad or 1985 grad and the difference gets wider and wider. This will likely continue significantly in physical therapy for the next ~ 50 years. In 2025 DPT education will be far and away superior to what it is now. In 2035 it will be better yet, and so will outcomes. Physical therapy education has evolved and is still evolving. It doesn't or hasn't happened at the flick of a switch. As others have said and most recognize, the MPT was at or very close to doctorate level to begin with. When the first DPT schools initially switched to DPT from MPT yes they were close to the same. That was then and this is now. If PT training was still MPT it would be better than it was in 1998, but IMO the transition to a DPT adds extra beyond what that would be.

"...but IMO the transition to a DPT adds extra beyond what that would be." - Your entire post is opinion and conjecture, but the last sentence is the only place you acknowlege that.


Is there another variable that could result in overall better outcomes for physical therapy patients other than entry-level education and years of experience?

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[engmedpt]

**Removing post to keep this thread on topic for Fiveboy11 and Jesspt**

 

[Fiveoboy11]

"The article you cite is 17 years old" - Well, technically it is an editorial, written by the Editor-in-Chief Emeritus of PTJ, God rest his soul.

It's an outdated editorial.

"In my mind, the physical therapy curriculum likely is markedly different now than it was in 1998" - Your opinion, although I would agree that the curriculum at most schools is likely different than it was 17 years ago.

At most schools?

"Maybe you don't realize it or don't want to but it is there without doubt." - And now, you are proposing that your opinion is fact that cannot be doubted, even though you were not in a program in 1998 and do not provide any supporting evidence.

There is significant positive difference in physical therapy education now compared to any PT school or degree in 1998 or prior to it.

"How in the wide world could the profession 20 years ago compare to it now?" - I can't. And wouldn't. The profession has changed. We have more research which points to the efficacy of typical PT interventions.

I'm glad you acknowledge this

"How in the wide world could the average new PT grad 20 years ago compare to the new grad now? PT students 20 years ago didn't have as good of information to study, teachers didn't have as good of information to teach." - Well, they can't, because as you accurately state, the BSPT graduate had less quality evidence to guide their clinical treatments. But you're comparing apples to oranges here.

I am comparing apples to oranges but thought I was arguing with someone who thought it was apples to apples. The BSPT grad had much more disadvantage beyond less evidence to guide treatments.

"Citing that when a school initially changed it only added 3 classes is not remotely persuasive." Is your argument persuasive? You have provided only opinion, despite being educated as a DPT in an evidence-informed practice environment. *As an aside here, PT was embracing EBP as far back as the early 1990's - it existed prior to the DPT.

You don't always need evidence. I'd hope our profession wasn't wasting its time and money on "studying" whether contemporary PT education is only 3 more classes. It's longer in duration, there's more literature base, the profession has more expertise. Use some logic and common sense.
No doubt evidence informed practice existed prior to the DPT. Was it ever embraced or attached to any entry level degree besides the DPT?

"Physical therapy school now is 6 mo to 1 yr longer and YEAR ROUND. What's happening in that time, students are doing your 3 extra classes?" Well, we went to school for 2.5 years, year round at my school. I can't speak for other schools at that time. But I believe that some DPT programs are not 3 years in length. USA and South College come to mind. Are they taking fewer classes than other DPT students? How does your statement apply to them?

I'd say this is a rare exception. If those schools are not of the same length and breadth then they're not as good. On average and overall PT school now is superior to what it was 20 years ago whether it be compared to one of the first DPT schools or a BSPT school of the same time frame.

"Find me a PhD professor in a physical therapy (i.e. Of education) school who will say now (in 2015) that the schooling is about the same as it was 20 years ago." - Of course they're not the same - the technological advances that have occurred in the last two decades have markedly improved our ability to disseminate information. Your average DPT student today has a wealth of information at their fingertips, power point presentations from the class lectures available 24-7, and online resources to relevant journal articles, none of which were available to the typical PT student in the late 1990's.

It's as if you agree that contemporary PT education is better but you have a super bias against "the DPT" or something.

 

[Fiveoboy11]

"...but IMO the transition to a DPT adds extra beyond what that would be." - Your entire post is opinion and conjecture, but the last sentence is the only place you acknowlege that.

Your posts are based on what? Bias and editorial?

Is there another variable that could result in overall better outcomes for physical therapy patients other than entry-level education and years of experience?

I believe entry level education and years of experience correlate positively with outcomes. This is on average. It's not: I know this one new grad or old timer PT who sucks so its all the individual. No doubt the very best PT's out there are the ones who have been practicing the longest. I also believe experience effect on outcomes is dependent on the quality of the experience (i.e. Is that PT reflective? Does he/she critically think? Do they utilize resources/journals/evidence? Is there experience yielding mastery in to a limited extent or is it producing a bona fide expert that just gets better and better?).

 

[engmedpt]

What I mean by that is that you have your pure sciences like chemistry, biology, etc. This forms the fact-based context for what we do. Then you have the applied sciences like kinesiology, etc. which takes known scientific fact and applies it to the human body. Then you have clinical sciences like PT/OT which piggyback on the applied sciences. Then you have actual clinical practice which may or may not actually derive itself from clinical science. So when we talk about evidence-based practice in the clinic, what we are talking about is our interpretation of scientific fact which has been transmitted through several levels of application

This is like inception.

I took some time to think about this. I'm coming from a pure science degree: biology (life sciences concentration). My interpretation of what you've wrote and my limited volunteering experiences before acceptance were this:

PT evidence based practice is the applied incorporation of results from pure science research as well as social science research in one.

^What I mean by that statement is that the approach to patient care will vary with every single demographic: depressed, old, young, disabled, etc. Every one of those demographics may have trends in worldviews or in things that lead to motivation (i.e. making an obstacle course for peds with a sticker reward at the end). Some research I've perused focused on how to go about care and approach for each person into creating a plan of care (the applied pure science research) in order to reach the patient's goals in a smooth process. So to me it seems like it is psychology/sociology research coupled with the application of pt which has more and more pure science evidence that show the outcomes of work. Does that make sense at all or do I need to tweak my perspective more?

 

[truthseeker]

I believe I made my point. If it remains unacceptable to you, you may continue reading below.

You can’t handle the truth! …Son, we live in a world that has walls, and those walls have to be guarded by men and women with gait belts and goniometers. Who’s gonna do it? You? You, engmedpt? The APTA has a greater responsibility than you could possibly fathom. You weep for the MSPT degree, and you curse the APTA for creating a tuition disaster. You have that luxury. You have the luxury of not knowing what the APTA knows. That the MSPT’s death, while tragic, probably was necessary to award a degree that reflects the appropriate rigor and credit hours. And the APTA's existence, while grotesque and incomprehensible to you, stand by those credit hours. You don’t want the truth because deep down in places you don’t talk about at parties, you want the APTA on that wall, you need the APTA on that wall. We use words like direct access, differential diagnosis, clinical skills. We use these words as the backbone of a life spent defending something. You use them as a punchline. I have neither the time nor the inclination to explain myself to a man who rises and sleeps under the blanket of the direct access that the APTA thrives to provide, and then questions the manner in which the APTA provides it. I would rather you just said thank you, and went on your way. Otherwise, I suggest you pick up a pen and run a campaign to be an APTA board member. Either way, I don’t give a damn what you think you are entitled to.

AWESOME!!!!

 

[truthseeker]

Thank you for this excellent post.

And thanks everyone who has responded. This thread has changed my perspective on the DPT quite a bit actually, I'm glad I started it. The idea that perhaps the extensive MSPT degree was already deserving of doctorate nomenclature without the addition of much coursework hadn't really occurred to me.

I got my MSPT in 1991. I was an ATC prior to that so I am probably atypical. When I came out I felt very prepared to do differential dx and basically function as a PT/ATC. When my PT school transitioned to a DPT program (14 years into my career as a PT), I took maybe 6 more classes and did a capstone project. I can honestly say that it didn't change my practice patterns at all. I don't think I learned much that I hadn't learned in the MS program/BS AT program before or by attending CEUs and reading.

That said, the DPT is a good thing in the long run, IMO but probably the main difference is that the grads are a little older and hopefully wiser. They may come out a little more prepared to deal with the WORLD and a little better prepared professionally.

 

[jesspt]

It's as if you agree that contemporary PT education is better but you have a super bias against "the DPT" or something.

I do indeed agree that current PT education is likely better than it was 15 to 20 years ago. I don't feel that I have a bias against the DPT, or those who hold it. I am "pro" PT, which in its current state is practiced by those who hold a BS, MS or DPT degree.

I believe entry level education and years of experience correlate positively with outcomes. This is on average. It's not: I know this one new grad or old timer PT who sucks so its all the individual. No doubt the very best PT's out there are the ones who have been practicing the longest. I also believe experience effect on outcomes is dependent on the quality of the experience (i.e. Is that PT reflective? Does he/she critically think? Do they utilize resources/journals/evidence? Is there experience yielding mastery in to a limited extent or is it producing a bona fide expert that just gets better and better?).

So you're saying that this is your overall opinion but avoiding using examples of individuals you've encoutered in your time as a clinician. I'm not sure how this lends weight to your argument.

Here's my take on the DPT, a.k.a. my OPINION:

• "Bashing" on a fellow clinician for the degree they have obtained does no one any good and doesn't help the profession. At all. Those who engage in this behavior are acting unprofessionally and I can't see any situation or context where this would ever by appropriate.
• The DPT, at least in part, was an adjustment designed to address the fact that MSPT programs' credit load was far in excess of a typical master's degree and was nearly at a doctoral credit level for many programs
• The course work that supposedly sets the DPT significantly apart from the MSPT was present in at least my MSPT program (and apparently Truthseeker's as well). I can't state with any certainty how rigourous my preperation was in diff. diagnosis, radiology, etc compared to current programs because I have not returned for a transitional DPT.
• There were also some political reasons why the DPT was pursued: the desire to be seen by the lay public as a "doctoring" profession, the possibility that a work force of doctorally trained therapists might positively impact the pursuit of meaningful direct access, etc.
• Outcomes between DPTs, MSPTs and BSPTs are likely not that different, and I am not convinced that it is the preparation of the DPT trained clinician that is the cause of this. Rather, the body of evidence that all PTs have to draw from today is far more vast and convincing than it was 15 to 20 years ago. It is this variable that could just as likely be the primary reason why "less" educated PTs could achieve the same outcomes as "more" educated PTs.
• The DPT as it is surrently constructed is not a problem for the profession, and is likely good for it in the long-term

My advice the DPT recent graduates, a.k.a. take it or leave it:

• Be humble. Arrogance is unbecoming a professional. Learn from the PTs you work with, which may mean that you learn which professional behaviors you will model and which you most certainly will not.
• Recognize that the transition to the DPT as the entry-level degrees was not unanimous within the profession, and there is obviously still some debate about the merits of that decision amongst the profession's members. Those who are skeptical of its benefits, whether it be from insecurity or otherwise, will judge the efficacy of the DPT degree in training a better entry-level practitioner based on how you interact with your patients/peers/employer, as well as the outcomes/impact you achieve. It is not fair, but it is likely a reality.
• Be a good PT. I see posts on this site about PT students who can't wait to get into the work force so they don't have to have all of this research shoved down your throat. Get real. If you're doing to job right, you'll be reading nearly as much research for the first few years of your career as you do in PT school. Do not get complacent with this once you graduate. Note: This is not directed at any particualr poster.

 

[DesertPT]

I do indeed agree that current PT education is likely better than it was 15 to 20 years ago. I don't feel that I have a bias against the DPT, or those who hold it. I am "pro" PT, which in its current state is practiced by those who hold a BS, MS or DPT degree.



So you're saying that this is your overall opinion but avoiding using examples of individuals you've encoutered in your time as a clinician. I'm not sure how this lends weight to your argument.

Here's my take on the DPT, a.k.a. my OPINION:

• "Bashing" on a fellow clinician for the degree they have obtained does no one any good and doesn't help the profession. At all. Those who engage in this behavior are acting unprofessionally and I can't see any situation or context where this would ever by appropriate.
• The DPT, at least in part, was an adjustment designed to address the fact that MSPT programs' credit load was far in excess of a typical master's degree and was nearly at a doctoral credit level for many programs
• The course work that supposedly sets the DPT significantly apart from the MSPT was present in at least my MSPT program (and apparently Truthseeker's as well). I can't state with any certainty how rigourous my preperation was in diff. diagnosis, radiology, etc compared to current programs because I have not returned for a transitional DPT.
• There were also some political reasons why the DPT was pursued: the desire to be seen by the lay public as a "doctoring" profession, the possibility that a work force of doctorally trained therapists might positively impact the pursuit of meaningful direct access, etc.
• Outcomes between DPTs, MSPTs and BSPTs are likely not that different, and I am not convinced that it is the preparation of the DPT trained clinician that is the cause of this. Rather, the body of evidence that all PTs have to draw from today is far more vast and convincing than it was 15 to 20 years ago. It is this variable that could just as likely be the primary reason why "less" educated PTs could achieve the same outcomes as "more" educated PTs.
• The DPT as it is surrently constructed is not a problem for the profession, and is likely good for it in the long-term

My advice the DPT recent graduates, a.k.a. take it or leave it:

• Be humble. Arrogance is unbecoming a professional. Learn from the PTs you work with, which may mean that you learn which professional behaviors you will model and which you most certainly will not.
• Recognize that the transition to the DPT as the entry-level degrees was not unanimous within the profession, and there is obviously still some debate about the merits of that decision amongst the profession's members. Those who are skeptical of its benefits, whether it be from insecurity or otherwise, will judge the efficacy of the DPT degree in training a better entry-level practitioner based on how you interact with your patients/peers/employer, as well as the outcomes/impact you achieve. It is not fair, but it is likely a reality.
• Be a good PT. I see posts on this site about PT students who can't wait to get into the work force so they don't have to have all of this research shoved down your throat. Get real. If you're doing to job right, you'll be reading nearly as much research for the first few years of your career as you do in PT school. Do not get complacent with this once you graduate. Note: This is not directed at any particualr poster.

Fantastic post. Thanks Jess

 

[truthseeker]

Excellent post Jesspt. Your comment about the outcome comparison between BS, MS and DPT was particularly important. I would like to add my 2 cents:

The PT with a BS has more experience than the MS than the DPT simply because there haven't been BS degrees for quite some time. IF that BS PT has kept up with current research and practices they will be very much farther ahead than a new DPT grad. That said, the BS who phones it in and doesn't keep up, goes to CEU classes on the new applications of continuous vs pulsed ultrasound for example, will be very much behind the new grad DPT. Further, the pool that the DPTs are drawn from may have a bit of an advantage simply because it is harder to get in with all of the applicants for fewer spots. In the late 80's when I was applying it was difficult to get in partly because there were fewer schools but you could be certain that if someone did get in, they had considerable academic ability.

When I moved to the town where I practice now, the PT that was here before me, graduated from a certificate program but had not progressed his practice AT ALL and still managed to get ultrasound, hot packs, and massage done on everyone. In contrast to that, the PTs I worked with before I moved here had BS degrees and were very good, progressive, and not afraid to question the things they were taught in school when compelling evidence told them to do so.

 

[Fiveoboy11]

I do indeed agree that current PT education is likely better than it was 15 to 20 years ago. I don't feel that I have a bias against the DPT, or those who hold it. I am "pro" PT, which in its current state is practiced by those who hold a BS, MS or DPT degree.



So you're saying that this is your overall opinion but avoiding using examples of individuals you've encoutered in your time as a clinician. I'm not sure how this lends weight to your argument.

Writing examples really does not prove or support anything and I could easily do that. I could also make up examples and cite examples in support if my opinion that would really equate to nothing more than me seeing thru biased eyes. My overall opinion is that better education yields better outcomes. I argue this because it makes sense to me. If we disagree on this then lets just go back to a certificate in PT and do "whatever works" since outcomes are not affected by baseline education.

Here's my take on the DPT, a.k.a. my OPINION:

• "Bashing" on a fellow clinician for the degree they have obtained does no one any good and doesn't help the profession. At all. Those who engage in this behavior are acting unprofessionally and I can't see any situation or context where this would ever by appropriate.

Agree. DPT bashing unfortunately has happened a lot but I think it is decreasing in time.

• The DPT, at least in part, was an adjustment designed to address the fact that MSPT programs' credit load was far in excess of a typical master's degree and was nearly at a doctoral credit level for many programs

Agree that the transition was in part because of credit load. As opposed to stagnating why wouldn't the profession want to have its terminal clinal degree of the highest order? Are we not good enough or something? Should we just have continue to be a 3rd tier profession?

• The course work that supposedly sets the DPT significantly apart from the MSPT was present in at least my MSPT program (and apparently Truthseeker's as well). I can't state with any certainty how rigourous my preperation was in diff. diagnosis, radiology, etc compared to current programs because I have not returned for a transitional DPT.

I would think many aspects of physical therapy education have changed and improved and that the entire curriculum has evolved and changed slowly over time, probably at a faster rate in the past 20 years or so compared with any other time.

• There were also some political reasons why the DPT was pursued: the desire to be seen by the lay public as a "doctoring" profession, the possibility that a work force of doctorally trained therapists might positively impact the pursuit of meaningful direct access, etc.

The 80's seem to have been when we had the most success in direct access. Did we hit a plateau with this in the 90's and 2000's and felt that a nice byproduct of going to a DPT may help? Yes, I would think so.

• Outcomes between DPTs, MSPTs and BSPTs are likely not that different, and I am not convinced that it is the preparation of the DPT trained clinician that is the cause of this. Rather, the body of evidence that all PTs have to draw from today is far more vast and convincing than it was 15 to 20 years ago. It is this variable that could just as likely be the primary reason why "less" educated PTs could achieve the same outcomes as "more" educated PTs.

I think it depends how we look at it. For example. Take you Jesspt. Let's say hypothetically you went to PT school now vs 1998 vs 1980. Would your outcomes differ as a new grad? I would argue that they would, being better the more contemporary your education. Would you as a PT differ in time in those 3 scenarios? I would think you would. However if we want to compare a bunch of PT's outcomes without controlling for a million other variables (like experience) then baseline education would not show a difference. Compare the average new grad now with the average new grad in 1998 and I feel outcomes with the new grad now would be better.

• The DPT as it is surrently constructed is not a problem for the profession, and is likely good for it in the long-term

My advice the DPT recent graduates, a.k.a. take it or leave it:

• Be humble. Arrogance is unbecoming a professional. Learn from the PTs you work with, which may mean that you learn which professional behaviors you will model and which you most certainly will not.
• Recognize that the transition to the DPT as the entry-level degrees was not unanimous within the profession, and there is obviously still some debate about the merits of that decision amongst the profession's members. Those who are skeptical of its benefits, whether it be from insecurity or otherwise, will judge the efficacy of the DPT degree in training a better entry-level practitioner based on how you interact with your patients/peers/employer, as well as the outcomes/impact you achieve. It is not fair, but it is likely a reality.

No it definitely was not unanimous. There was and is too many PT's who thought of physical therapy and physical therapists as being secondary or ancillary and of DPT education as some kind of hoax.

• Be a good PT. I see posts on this site about PT students who can't wait to get into the work force so they don't have to have all of this research shoved down your throat. Get real. If you're doing to job right, you'll be reading nearly as much research for the first few years of your career as you do in PT school. Do not get complacent with this once you graduate. Note: This is not directed at any particualr poster.

 

[ptisfun2]

I do indeed agree that current PT education is likely better than it was 15 to 20 years ago. I don't feel that I have a bias against the DPT, or those who hold it. I am "pro" PT, which in its current state is practiced by those who hold a BS, MS or DPT degree.


Here's my take on the DPT, a.k.a. my OPINION:

• The DPT, at least in part, was an adjustment designed to address the fact that MSPT programs' credit load was far in excess of a typical master's degree and was nearly at a doctoral credit level for many programs
• The course work that supposedly sets the DPT significantly apart from the MSPT was present in at least my MSPT program (and apparently Truthseeker's as well). I can't state with any certainty how rigourous my preperation was in diff. diagnosis, radiology, etc compared to current programs because I have not returned for a transitional DPT.
• There were also some political reasons why the DPT was pursued: the desire to be seen by the lay public as a "doctoring" profession, the possibility that a work force of doctorally trained therapists might positively impact the pursuit of meaningful direct access, etc.
• Outcomes between DPTs, MSPTs and BSPTs are likely not that different, and I am not convinced that it is the preparation of the DPT trained clinician that is the cause of this. Rather, the body of evidence that all PTs have to draw from today is far more vast and convincing than it was 15 to 20 years ago. It is this variable that could just as likely be the primary reason why "less" educated PTs could achieve the same outcomes as "more" educated PTs.
• The DPT as it is surrently constructed is not a problem for the profession, and is likely good for it in the long-term

BRAVO for your 3rd sentence!!!!!

There is some at least anecdotal evidence for some of your opinion, but I am guessing you knew that. Load was too much for a MS degree. In fact, at my institution not a ton was added....I was not here, but I know 1 credit of differential diagnosis (up from 3), 1 credit of Pharm (which was just part of other courses), 1 credit in EBP (up from 2), and a more 'weighty' capstone were the changes from a 2.5 year to 3 year entry-level PT degree. Maybe a few more weeks of a rotation, but I am not too sure about that one as I don't deal with clinical education. Rigor has increased, but only because rigor has increased in graduate programs as technology allows a different method of teaching. Content is not much more rigorous from what I attended for a BS, and what I teach now.

BS, MS, DPT are all ENTRY-LEVEL degrees. You are now a minimally competent entry-level practitioner if you 'just pass the NPTE.' Foreign trained graduates with a substantially similar CAPTE curriculum can come to the US and take NPTE, and most of those folks have a BS.

EBP is the application of empirical evidence, clinical experience/expertise, and patient preferences to maximize patient outcomes. Patients are changing, clinical experience/expertise changes, and evidence changes. If you do not keep up with all of these things, I don't care what degree you have...you are not helping our profession.

 

[ptisfun2]

The PT with a BS has more experience than the MS than the DPT simply because there haven't been BS degrees for quite some time.

The last BS program closed in 2002, and the first DPT program started in 1996. So there will be lots of PTs with lots of different degrees for a while now.
In 1979, the APTA stated that PT should be a post-bac degree, so things take a while to change.

Just look how long direct access has been around (1957 - Nebraska or Nevada....I have NE on a presentation, but forget what state abbreviation that is )

 

[DesertPT]

Just look how long direct access has been around (1957 - Nebraska or Nevada....I have NE on a presentation, but forget what state abbreviation that is )

And NE would be Nebraska, lol

And according to this document from the APTA (http://www.apta.org/uploadedFiles/A.../Issues/Direct_Access/DirectAccessbyState.pdf) it was indeed Nebraska that obtained direct access in 1957. Nevada obtained it in 1985.

 

[Fiveoboy11]

BRAVO for your 3rd sentence!!!!!

There is some at least anecdotal evidence for some of your opinion, but I am guessing you knew that. Load was too much for a MS degree. In fact, at my institution not a ton was added....I was not here, but I know 1 credit of differential diagnosis (up from 3), 1 credit of Pharm (which was just part of other courses), 1 credit in EBP (up from 2), and a more 'weighty' capstone were the changes from a 2.5 year to 3 year entry-level PT degree. Maybe a few more weeks of a rotation, but I am not too sure about that one as I don't deal with clinical education. Rigor has increased, but only because rigor has increased in graduate programs as technology allows a different method of teaching. Content is not much more rigorous from what I attended for a BS, and what I teach now.

BS, MS, DPT are all ENTRY-LEVEL degrees. You are now a minimally competent entry-level practitioner if you 'just pass the NPTE.' Foreign trained graduates with a substantially similar CAPTE curriculum can come to the US and take NPTE, and most of those folks have a BS.

EBP is the application of empirical evidence, clinical experience/expertise, and patient preferences to maximize patient outcomes. Patients are changing, clinical experience/expertise changes, and evidence changes. If you do not keep up with all of these things, I don't care what degree you have...you are not helping our profession.

Please explain why the first time pass rate of the NPTE is 30-40% for foreign trained PT's and ~ 90% for US trained if the curriculum is substantially similar? Please also consider that the pass rate for the PTA exam amongst US and foreign trained is nearly identical. PT's who didn't graduate with a DPT have incredible bias against it. Their "observations" are not trustworthy but more so a reflection of what they want to be true.

 

[Fiveoboy11]

Here are contemporary CAPTE documents:
Physical Therapy Programs Fact Sheet
http://www.capteonline.org/uploaded...gram_Data/AggregateProgramData_PTPrograms.pdf

Page 17 shows quite an uptick in applicants to PT programs. I wonder if a more competitive applicant pool makes for better students and therefore a better overall student group.

Page 27 shows number of faculty who are certified clinical specialists. 2001 - 23% vs 2012 37%. I wonder if that yields higher quality instruction? How many certified clinical instructors in PT programs in 1980?

Rules of practice and procedure
http://www.capteonline.org/uploaded...tion_Handbook/RulesofPracticeandProcedure.pdf

Standards and required elements for accreditation of physical therapist education programs.
http://www.capteonline.org/uploaded...tation_Handbook/CAPTE_PTStandardsEvidence.pdf

Evaluative criteria for PT programs
http://www.capteonline.org/uploaded...reditation_Handbook/EvaluativeCriteria_PT.pdf

What were the comparative documents from say 1998 and prior? Does the AMA have them?

 

[engmedpt]

Please explain why the first time pass rate of the NPTE is 30-40% for foreign trained PT's and ~ 90% for US trained if the curriculum is substantially similar? Please also consider that the pass rate for the PTA exam amongst US and foreign trained is nearly identical. PT's who didn't graduate with a DPT have incredible bias against it. Their "observations" are not trustworthy but more so a reflection of what they want to be true.

^This trend is actually similar to IMGs trying to match and practice in the U.S. vs. US grads for allo. The numbers are not nearly as harsh percentage wise, but when you toss in Harry Potter's magic sorting hat for THE MATCH based on competitiveness, the amount of IMGs that end up practicing in lucrative specialties or matching at all is significantly lower than US grads. In order to practice, the AMA requires that the foreign grads complete a U.S. residency in order to practice. I'm very surprised that foreign graduates of PT programs do not have to complete a tDPT or some other requirement in addition to the NPTE. If the percentages are that different then the outcomes are clearly different.

 

[engmedpt]

@DesertPT

Can this become a sticky somehow? I'm not sure how that works honestly. The practicing physical therapists here have provided incredibly valuable perspective and information for students and prospective students that should be highlighted over other threads.

 

[Fiveoboy11]

Here's more resources

Outcomes Assessment in Physical Therapy education (2009 or later)
http://www.apta.org/uploadedFiles/A...tcomes_Assessment/OutcomesAssessment_Full.pdf

The intro and purpose to the above reference say a lot relevant to this debate

Essential competencies in Geriatric Physical Therapy for physical therapy schools (2011)
http://www.geriatricspt.org/pdfs/AGPT-PT-Essential-Competencies.pdf

Electrophysiological guidelines for PT school (2011)
http://www.apta.org/Educators/Curriculum/Section/Electrophysiology/CurriculumGuidelines/

Wound (2014)
http://www.apta.org/uploadedFiles/A...ources/Section/GuideIntegWoundinEducation.pdf

Neurology (2009 or later)
http://www.apta.org/Educators/Curriculum/Section/Neurology/CurriculumGuidelines/

Women's (2005)
http://www.apta.org/For_Educators/C...Health_Examination_and_Evaluation_(_pdf).aspx

Etc...
Looks like there's quite a lot going into PT school education quality and improvement nowadays. I'm sure all these efforts have existed though throughout the history of physical therapy education.
I will ask CAPTE for data to compare current PT schools to prior going back as far as possible (i.e. Fail out rates, info about faculty, etc). I'll ask the FSBPT for data on pass/fail on the NPTE going back as far as possible for US and non US trained for PT and PTA.

 

[truthseeker]

Please explain why the first time pass rate of the NPTE is 30-40% for foreign trained PT's and ~ 90% for US trained if the curriculum is substantially similar? Please also consider that the pass rate for the PTA exam amongst US and foreign trained is nearly identical. PT's who didn't graduate with a DPT have incredible bias against it. Their "observations" are not trustworthy but more so a reflection of what they want to be true.

I suggest language barriers

 

[AlanWattsBlues]

Please explain why the first time pass rate of the NPTE is 30-40% for foreign trained PT's and ~ 90% for US trained if the curriculum is substantially similar?

I've wondered about this myself and thought that it might have something to do with many of the test takers not being native english speakers. If your comment about PTAs is true, then it would tend to negate that idea:

Please also consider that the pass rate for the PTA exam amongst US and foreign trained is nearly identical.

But where is your source for this? I looked on the NPTE website and all I could find was this:

https://www.fsbpt.org/FreeResources/NPTEPassRateReports/NPTEExamYearReports.aspx
​

Foreign trained PTA pass rates are not reported due to the small number of people in that cohort of test takers. If the FSBPT doesn't report those numbers, then how do you have them?

 

[Fiveoboy11]

I suggest language barriers

PTA foreign trained and US trained pass the same. It's not language barrier.

 

[Fiveoboy11]

I've wondered about this myself and thought that it might have something to do with many of the test takers not being native english speakers. If your comment about PTAs is true, then it would tend to negate that idea:



But where is your source for this? I looked on the NPTE website and all I could find was this:

https://www.fsbpt.org/FreeResources/NPTEPassRateReports/NPTEExamYearReports.aspx
​

Foreign trained PTA pass rates are not reported due to the small number of people in that cohort of test takers. If the FSBPT doesn't report those numbers, then how do you have them?

Because it's been posted in the past. I'm asking for that data.

 

[AlanWattsBlues]

Because it's been posted in the past. I'm asking for that data.

I'd be interested to see that if you ever find it. My immediate reaction is skepticism...I doubt that the two groups have "nearly identical" pass rates, both now and historically. Even if they do, it seems that the non-US trained PTA cohort might be sufficiently small that comparisons aren't terribly meaningful.

I imagine most US trained PTs are taking the licensing exam soon after graduation; many foreign trained PTs may have worked for awhile before moving here and attempting the test. I wonder how well US grads would do on the licensing exam a few years out of school when their knowledge has gotten deeper into one domain (hopefully) and eroded in others. Even with time spent on a review course and practice exams, I bet it would be lower. Consider the non-native English speakers and there start to be many confounding variables.

And before a person can sit for an exam, their education has to get verified as substantially equivalent to a US PT education:

https://www.fsbpt.org/SecondaryPages/ExamCandidates/NationalExam(NPTE)/EligibilityRequirements.aspx

 

[ptisfun2]

Please explain why the first time pass rate of the NPTE is 30-40% for foreign trained PT's and ~ 90% for US trained if the curriculum is substantially similar? Please also consider that the pass rate for the PTA exam amongst US and foreign trained is nearly identical. PT's who didn't graduate with a DPT have incredible bias against it. Their "observations" are not trustworthy but more so a reflection of what they want to be true.

I cannot answer about PTA as I am not familiar with the exam or the education in the US.

FCCPT certifies that the education of a foreign educated PT applicant for the NPTE is 'substantially similar' to that of a CAPTE accredited program. If not, the PT applicant has to take courses, do a rotation, etc. to meet the standard. I imagine the standards are as watered down and easy as CAPTE standards, but that is just based on my opinion of CAPTE. Why foreign educated don't pass NPTE as much as US educated is probably not degree related, but my guess (and I have only interacted with foreign educated PTs from a CAPTE program so cannot say for certain):
1. May have practiced for a bit in their home country while waiting for immigration, etc, so not right out of school. I think most PTs in this country would shed a tear if asked to take NPTE 2,5,10,15, etc. after graduating.
2. CAPTE sets up education to follow NPTE....not 'teaching to the test' as much as making sure CAPTE criteria is in line with FSBPT practice analysis
3. Practice, practice, practice....for many US schools, the comp exam is Scorebuilders or something similar. Many US programs also have board review courses that students can take or facilitates the students scheduling something with a company
4. Social support. New US grads have at least 20 something odd people in the same boat as them.. their classmates. Now that so many states let you take NPTE before graduation, the students are in a good place to study together. In addition, friends from a class (or 2) ahead can give them ideas about studying. Those foreign educated may not have people who have history, experience, or circumstances with the NPTE.
Again, I am guessing. As a researcher, I never speculate. But there are no data. You caught me with just 2 cups of coffee, so I am out of my mind until I have more

And there are no data that shows NPTE score means you will be a good PT, but that is a story for another day

 

[ptisfun2]

I'd be interested to see that if you ever find it. My immediate reaction is skepticism...I doubt that the two groups have "nearly identical" pass rates, both now and historically. Even if they do, it seems that the non-US trained PTA cohort might be sufficiently small that comparisons aren't terribly meaningful.

I imagine most US trained PTs are taking the licensing exam soon after graduation; many foreign trained PTs may have worked for awhile before moving here and attempting the test. I wonder how well US grads would do on the licensing exam a few years out of school when their knowledge has gotten deeper into one domain (hopefully) and eroded in others. Even with time spent on a review course and practice exams, I bet it would be lower. Consider the non-native English speakers and there start to be many confounding variables.

And before a person can sit for an exam, their education has to get verified as substantially equivalent to a US PT education:

https://www.fsbpt.org/SecondaryPages/ExamCandidates/NationalExam(NPTE)/EligibilityRequirements.aspx

Sorry I replied without reading your post.

 

[brooklynyc]

Very interesting thread. Great topic!

 

[AlanWattsBlues]

Sorry I replied without reading your post.

Great minds think alike

 

[Sheldon]

And NE would be Nebraska, lol

And according to this document from the APTA (http://www.apta.org/uploadedFiles/A.../Issues/Direct_Access/DirectAccessbyState.pdf) it was indeed Nebraska that obtained direct access in 1957. Nevada obtained it in 1985.

Nebraska has had DA ON PAPER since 1957. It is truly not unfettered and is controlled by the third-party payors, who usually don't pay unless an MD script is provided. It's a farce in Nebraska as far as DA is concerned. Like a Russian mail-order bride...

 

[DesertPT]

Nebraska has had DA ON PAPER since 1957. It is truly not unfettered and is controlled by the third-party payors, who usually don't pay unless an MD script is provided. It's a farce in Nebraska as far as DA is concerned. Like a Russian mail-order bride...

Thanks for pointing this out Sheldon. Indeed this is probably the main roadblock to the application of direct access even in the 17 or 18 states where it is legally fully unrestricted.

Although I've read a few things that claim that more and more insurance plans are not requiring a script for PT anymore. Particularly that HMO's generally don't require one. Do you find this to be the case where you practice? Do you find that there are certain types of third-party payors who are more likely to require a script than others?

Really if insurance companies were smart they wouldn't require one. That's just one more doctor's visit they have to pay for. I can't imagine what sort of evidence payors must be clinging onto that requiring a script for PT actually decreases the amount they pay out. Lots of plans will pay for an acupuncturist without a script but not a PT?? You'd think these actuaries would be smarter than that.

 

[Fiveoboy11]

Physical therapist examination

% Passing - PT

2013* 2012 2011 2010 2009
First-Time Candidates – Graduates of
U.S.-Accredited PT Programs 90 88 89 87 87
First-Time Candidates – Graduates of
Non-U.S. PT Programs 33 30 25 29 41
First-Time Candidates - All 82 80 75 80 77

http://www.fsbpt.org/FreeResources/NPTEPassRateReports/NPTEExamYearReports.aspx

The PTA non US rates were removed but they were nearly the same when the data was available.
I suppose it is possible this would be caused by postponement of when the test is taken and because lack of study partners IF the prior PTA data was flawed. If not then wouldn't we see PTA rates of US vs non US differ as well because of potential for language barrier, postponement of test taking, lack of study parters? I would question whether any of these factors would produce such a lower overall pass rate besides (assuming substantially similar education) besides language barrier. But language barrier to me is unlikely. Good luck getting a job in the US as a PT without proficiency in english. And don't PT's with english as a second language have to pass a TOEFL test? I would bet that the majority of foreign trained PT's who sit for the NPTE are proficient in english. Where are the majority from? Canada? But we will hopefully soon find out with data going back much farther. If the pass rates become more similar back in time for example.

 

[DesertPT]

I would bet that the majority of foreign trained PT's who sit for the NPTE are proficient in english

Perhaps a majority, I don't know. But if you read through the many threads about the NPTE that get posted on this forum, you'll see that essentially everyone who is reporting having to take the exam multiple times (sometimes 5 and even 6 times just to barely pass) is a non-native English speaker. Obviously that is biased because it's just this forum, but it does suggest that language barrier is a huge factor in the dismal pass rates.

But honestly if what you are trying to argue is that PT education in the US is more robust than it is in other countries, why does everyone seem to have a problem with that? We can't necessarily prove it that easily, but I don't see why we can't say that it's likely, at least to an extent.

 

[DesertPT]

@DesertPT

Can this become a sticky somehow? I'm not sure how that works honestly. The practicing physical therapists here have provided incredibly valuable perspective and information for students and prospective students that should be highlighted over other threads.

Not a mod, sorry. By all means link to it in as many other threads as you'd like.

 

[engmedpt]

Not a mod, sorry. By all means link to it in as many other threads as you'd like.

You've been around much longer than me. Can you just really quickly explain what a mod is?

 

[Azimuthal]

You've been around much longer than me. Can you just really quickly explain what a mod is?

The moderator (mod) is DancerFutureDPT.

I'm her self appointed assistant .

 

[engmedpt]

The moderator (mod) is DancerFutureDPT.

I'm her self appointed assistant .

It seems two things have flown over my head in this thread

Thanks.

 

[Fiveoboy11]

A review of international physiotherapy education accreditation systems:

http://www.alliancept.org/pdfs/FQR_Final_Report_2013_nov_29-Accreditation_Project_CBeggs.pdf

CAPTE takes them all

Canada physiotherapy association anual report:

http://www.alliancept.org/pdfs/annual_report_2013.pdf

Nationalities most to least common as non canadian trained sitting for canadian PT exam - India>phillipines>UK>australia>US>pakistan>iran>brazil>nigeria>ireland.

Pass/fail rates clinical component of Canada exam
2010 canadian educated pass 95, fail 5
2010 non canad educat. Pass 70, fail 30
2011 can educ pass 93, fail 7
2011 non can educ pass 62, fail 38
2012 can pass 88, fail 12
2012 non can pass 44, fail 56
2013 can pass 92, fail 8
2013 non can pass 58, fail 42

Written component
2010 can pass 94, fail 6
2010 non can pass 50, fail 50
2011 can pass 94, fail 6
2011 non can pass 64, fail 36
2012 can pass 94, fail 6
2012 non can pass 44, fail 56
2013 can pass 95, fail 5
2013 non can pass 53, fail 47

Average pass rate for foreign trained Canada test takers is 55.6 vs foreign trained US test takers is 31.6

 

[AlanWattsBlues]

But honestly if what you are trying to argue is that PT education in the US is more robust than it is in other countries, why does everyone seem to have a problem with that?

Good point. I wouldn't be surprised if the PT education in the US is more robust than many places in the world by some measures. I only jumped into this because I was suspicious of the assertion that the non-US PTA test takers performed similarly to the US-trained PTAs.

On the the meat of this conversation: My gut tells me that there's not a huge difference between what someone got out of a masters program and what someone gets out of a doctoral program. Though I've met folks who graduated long ago and wondered if they would've even gained admission to a program these days...

But then some of those folks who entered the PT world with a bachelor's went on to lay the foundation for the profession that I'm fighting to break into. So I'm cautious about painting any group with a wide brush.

This conversation strikes me as just an outgrowth of an us vs them mentality.... people have that mentality all over the world. They have since the beginning of time. And they'll continue until the day we all tear each other to shreds. But in the meantime, I find these conversations to be about the most boring and worthless dialogues to engage in. I only got involved because I give a damn about statistics, and I thought that some numbers were being fudged.

 

[Fiveoboy11]

2000-2005 fact sheets from CAPTE and a spreadsheet

 

[Fiveoboy11]

2006-2010 fact sheets from CAPTE

 

[Fiveoboy11]

2012 CAPTE fact sheet

 

[engmedpt]

Welp. There are some stats.

 

[AlanWattsBlues]

Looking at the 2011 PT fact sheet you can see that during the period from 2001-2011, the average total length of a program increased 15.6 weeks (page 11). This coincided with the proportion of Master's degrees awarded dropping from 86% to 4.6% (page 14).

So it looks like the transition from a Master's to a Doctorate basically entails adding in one extra semester. Only now the doctoral programs cost $20k more… (page 8. ). Doesn't seem like a huge jump in education, and the universities get a bit of a windfall

Maybe there are other takeaways from these numbers, but that's the big one that jumps out at me. Interested to see if others disagree with this assessment or see something else buried in there.

 

[engmedpt]

^Was master's already yearround as well?

 

[truthseeker]

^Was master's already yearround as well?

mine was. started in the summer, went through the school year, then had some classes the second summer, then year round, graduated in late May

 

[Fiveoboy11]

So I tried to compare tuition changes in PT school vs med school and dental. I couldn't find data to compare with dental or OT or optometry.

If my calculations are right then PT schools comparing 2000 and 2010 tuition have increased residential public by 178% and residential private by 61%. Medical school increase was respectively 107% and 51%. Dental increased 96% and 80%.

Looks like public PT school tuition hikes are excessive but then again they look to have been dirt cheap to begin with and went from being 1/3 of private to 1/2.

http://www.adea.org/publications/tde/documents/allpredoctoralstudentdebttuitiongraphs.pdf

https://services.aamc.org/tsfreports/report_median.cfm?year_of_study=2011

 

[engmedpt]

increased residential public by 178%

 

[engmedpt]

Dentals the worst I believe in terms of just tuition. I read 67k a year in the dent forum for a school

 

[AlanWattsBlues]

If my calculations are right then PT schools comparing 2000 and 2010 tuition have increased residential public by 178% and residential private by 61%.

Those numbers look right. I did an independent calculation and came out to a slightly more dismaying picture. Between 2000 and 2011, average public instate total cost increased 201% ($16k to $47k). For private it was 74% ($51k to $88k). Our differences may not just be the inclusion of 2011...I'm looking at averages, Five-O might have been looking at median...and they split out the data many ways, so I'm not surprised there's a slight difference. The overall story is the same.

I think that this major price increase might be at the heart of some of the intergenerational conflict within the profession. It's just hard to believe that we could be paying so much more and not be getting a proportionally better education. At some point cognitive dissonance creeps in and we start saying to ourselves: my $50k DPT education has to be much better than a $15k MSPT education from 15 years ago.

 

[DesertPT]

In the 11 year time period between 2004 and 2015 the base resident tuition and fees for a full-time bachelor's student at my state university went from $2033/semester to $5078/semester...Exactly at 150% increase. the same is true at many state universities around the country. What you guys are reporting is not as much a problem with the move to the DPT as it is with the higher education system of the United States in general. Now it is true that the DPT being a semester longer on average makes it more expensive by default. But if the degree had continued to be called the MPT I'm confident tuition still would have risen at a comparable rate.

And thanks again everyone for a lot of excellent posts in this thread.