This might ruffle a few feathers, but I firmly believe that residencies should be required before any physical therapist (PT) is allowed to enter fellowship training. In medicine, a physician must complete residency before entering into fellowship. After finishing, they may choose to go into fellowship or “sub-specialty training.” The residency is the stepping stone. For most PT fellowship programs, a therapist can apply as long as they have any of the following: (1) completion of an APTA residency; (2) be board-certified in an APTA specialty; or (3) have a year of experience within the field (APTA, 2013). The problem with these requirements is that they are not created equal. There are too many pathways to obtain certification. A PT with one year of experience does not have the same level of competency as a PT who finished a full-time residency.
Do you see the problem? In medicine, you know that the physician in fellowship has already completed a certain level of training. For a PT who is fellowship trained, you do not know what type of experience or level of skill they have. It could be as little as a year. I think the American Academy of Orthopedic Manual Therapists (AAOMPT) would elevate its fellowship credential (FAAOMPT) even higher with more stringent standardization. Should there be exceptions? Maybe. If exceptions are to be made, the other minimum requirements should be raised across all fellowship programs. PTs entering fellowship without residency should have at least 3-5 years of experience AND be board-certified in a specialty. This guarantees a certain level of competency and provides standardization to obtaining fellowship status.
The same goes for obtaining APTA board-certification without completing a residency: a therapist should be required to work at least 2-3 years before they can even sit for the exam (not after having only 2000 hours of experience). My residency director once told me that finishing a dedicated full-time residency (not part-time) is the equivalent to practicing for 4-5 years (being in the field for almost 5 years, I believe her). How then, does a therapist become board-certified after practicing for one year without a residency? That does not make much sense. Should there be exceptions to this rule? Absolutely. My wife is a pharmacist who has experience in retail and clinical pharmacy. She has interest in becoming a board-certified pharmacotherapy specialist (BCPS); however, she did not complete a post-doctoral residency. Consequently, she must have 3 years of experience before she can even qualify for the exam and obtain the established credential. If she had completed a residency she would be able to sit for the exam sooner. Rich Severin touched on this in an interview with New Grad Physical Therapy (NGPT):
“In many ways, the residency is a process of refining one’s ability to solve problems – and not necessarily just clinically oriented questions either. Of course, there are psychomotor skills that are learned and mastered but the thought process is what I feel is the most important benefit of residency training. This process of refinement can be obtained without completing a residency program if one has access to a motivated mentor in the right practice setting; however having access to both of those components is not too common” (NGPT, 2016, paragraph 2).
By raising the minimum requirement of 3 years clinical experience, it ensures that the PT who is board-certified has some mastery of psychomotor skills (ex. manual therapy/exercise prescription) AND refined thought process (ex. clinical decision-making, differential diagnosis, etc.). Perhaps that is the other problem: while the APTA board-certification is standardized, there is no motor-skill component to ensure that the therapist is proficient with certain techniques within their specialty.
Most PTs do not choose to enter residency after graduating from school. I was one of only three students out of my class to choose this route. Unfortunately, the return on investment (ROI) for a PT is nowhere near that of a physician; consequently, most PTs do not enter residency because of the lower salary (I would love to touch more on this, but that is beyond the focus of this post). It is understandable given that everyone has a different financial situation. I was fortunate enough to enter residency straight out of graduate school because my wife was working at the same time.
A streamlined, standardized pathway for advanced specialty certifications and fellowships is important. It makes more sense and it is less confusing for patients, PTs, and other healthcare professionals. The current system does not guarantee a certain level of competency because the requirements are too low and the routes are too many. Below is a more simplified pathway:
APTA Board-Certification (must have ALL of the following):
Active license to practice PT
Completion of an APTA credentialed residency
Have at least 3 years of documented clinical experience in the related field
Fellowship Certification (must have ALL of the following):
Active license to practice PT
Completion of an APTA credentialed residency AND be APTA board-certified
Be APTA board-certified AND have at least 3 years of documented clinical experience in the related field
© by ThePTNurseGuy, 2017
American Physical Therapy Association (APTA). (2013). Presentation objectives clinical residency clinical fellowship. Retrieved from http://www.apta.org/uploadedfiles/aptaorg/national_conferences/nsc/programming/handouts/residency_fellowships.pdf
New Graduate Physical Therapy (NGPT). (2016). Pursuing residencies, specialties, or research: an interview with rich severin. Retrieved from https://newgradphysicaltherapy.com/physical-therapy-residency-new-grads/