PT Education: The Next Generation Needs Us
8 minute read
Education is big in our profession.
When clinicians ask what led me to physical therapy as a career choice, I always tell them it was a "happy accident," and that I originally wanted to be an elementary school teacher.
Each and every therapist (without fail) has smiled at my response and said: "Well, that's because we basically are teachers!" or something along those lines. I've heard it from countless therapists across my rotations—from orthopedics to inpatient rehabilitation to pediatrics.
As physical therapy students, we've lived in the education world for a long time. We've graduated from high school, college, and maybe even gotten graduate level degrees before pursuing our physical therapy degree. As future clinicians, we spend time in class learning from our teachers the very things that we will go on to teach our patients and their families. Once we become practicing clinicians, many of us will take on students during their clinical rotations, and a few of us will go on to get postprofessional degrees to start careers in research. A lot of us will go on to teach in physical therapist and physical therapist assistant programs to educate the next generation of our profession.
There are several ways to advance your practice to be considered for a position in physical therapy academia. I've always thought of going back into education after practicing for some time. If you look at the faculty lists of Commission on Accreditation in Physical Therapy Education (CAPTE) accredited doctor of physical therapy programs, this means that I will either need a clinical specialization and many years of clinical practice under my belt, or an additional academic degree (eg, PhD, EdD, MBA, MPH). However, the idea of completing another degree right now is less than appealing.
Like many others considering the same career path, I will be graduating from physical therapy school with a considerable amount of student debt. Pursuing another degree during the standard 10-year repayment period just seems like a terrible financial investment. I'm not sure that in 10 years I will have the time to put aside the dedication toward a career because I may have commitments that I currently do not have (eg, a spouse, a mortgage, a family). I haven't even started my career as a clinician yet, but I do know that I want to be more involved with the education of physical therapy students. Maybe I'll teach a class or two, be an advisor, or help out with lab instruction, while still treating patients. Tenure isn't a word that I see myself seeking anytime soon, but I might give it a try one day if I find that I'm passionate enough about a topic to get a PhD in it.
Before I applied to physical therapy school, I thought that only medical doctors did residencies; now, I am considering pursuing a residency in my near future. However, while this prepares me to be more of a clinical expert, it may not be all that I need to go back and teach one day at a program.
Clinical expertise is expected the longer you are in practice; your time in a clinic is not just spent treating your patients, it is also time spent advancing your knowledge and applying concepts from evidence to patient care, and communicating what you've learned to coworkers and other providers to advance the profession as a whole.
Even if I were to sit for a specialization exam, I would still be expected to continue to advance my practice beyond that level of knowledge of the test, as any health care provider should, because practice changes!
In order to be considered for full-time faculty positions, and especially for tenure track or program leadership faculty positions, a postprofessional degree (ie, PhD, EdD) is essentially required. Not only do you have to be a physical therapist (PT) to be a professor, you also have to bring something else that differentiates you from the crowd to the table. What talents, skills, and breadth of knowledge do you have to impart on the next generation of students? And a follow-up question because I'm curious: What did you have to give up in the process of achieving the level of knowledge you acquired?
With that in mind, it's important to remember that great clinicians are some of the best teachers this profession has. Great clinicians have handed down the basics of physical therapy to each of their students, and each of those students to theirs, in turn.
Each and every one of you who has read this far into this article can pinpoint at least 1 clinical instructor (CI) who took the time to cultivate your skills, your passion, and your clinical confidence. I've been fortunate enough to have multiple CIs who have done so; I've also been fortunate enough to learn from faculty who do the same.
Throughout my time in physical therapy school, what I've learned is that the amount of letters behind someone's name doesn't always guarantee that they will be a good teacher—the interest in their students, however, does. It makes me sad that some clinicians who would otherwise be wonderful teachers choose to forgo a career in education because they felt that they wouldn't stand a fighting chance against their PhD or EdD level-educated peers. There should be a way to incorporate these candidates into education on a greater scale without making them sacrifice extra time, money, energy, and sanity into a degree they don't really desire in order to do what they can already do without it.
But physical therapy education is quickly changing. The cost of our education is rising exponentially when compared with rates for entry-level physical therapist salaries; the desire to become a PT has been leveraged by public and private institutions alike in order to make a profit off of each class that comes through, despite a programs' best efforts to keep costs as low as possible.
As American Physical Therapy Association (APTA) President Sharon Dunn, PT PhD, alluded to in her 2019 Presidential Address at APTA's NEXT Conference & Exhibition, this global tuition hike is preventing many new clinicians from reinvesting in themselves, whether that be through continuing education, pursuing a residency, pursuing that extra degree, or doing something else that will advance their clinical skills and knowledge that has a monetary cost. It also has decreased the amount of people who will go back and become educators in the profession. Many individuals will stay clinicians for the duration of their careers simply because they cannot afford the short-term pay cut of going part-time, while pursuing a postprofessional degree, or even a residency for 1 year. They need higher paying clinical jobs in order to keep paying off their student debt for where they are currently in their lives. They can't think about the slight monetary loss in the long run that pursuing a terminal degree would cost them for fear of defaulting on loans. When combined with the increased need of a postprofessional degree in each faculty member's repertoire that programs state as required—both by universities and CAPTE—who will be left to fill the faculty positions once current faculty members retire from physical therapy programs across the country? And who will step forward to fill new positions at new programs that are opening?
Obviously, this is a gross oversimplification; staffing of programs is a multifactorial issue. However, if universities require certain percentages of each department's faculty to have higher level postprofessional degrees apart from their professional doctorates in order to secure grant money and funding (and maintain CAPTE accreditation), with the increasing cost of education, it's not hard to see how quickly some physical therapy programs will run out of candidates who apply to fill the positions and who fit their prerequisites.
What if there is a PT who wants to teach, has an excellent record as a clinician, has a specialization, is able to carry out a lecture that enables first- and second-year students to clearly grasp concepts, and holds their attention, but does not have the terminal level degree? Should they continue to be part of the applicant pool? What if they are competing against an applicant who has all necessary requirements, but is not interested whatsoever in developing new clinicians, and is only present for research purposes? Who should get the position?
Now more than ever, the profession needs individuals who are excited and energized to fill the staffing demands of the future. There aren't enough candidates who are both PT and PhD educated to fill the gap as it stands today, and money is definitely a big factor for us. Do we need more PTs willing to go on to pursue a PhD? Absolutely. We will always need new evidence to better practice on a global scale. But we also need to find a fix to help incorporate clinicians back into education because their expertise with one-on-one patient care is just as important as the expertise of those PhD-educated individuals who are changing practice through research. I'd be willing to bet the vast majority of us chose this profession due to the amount of patient contact we get, and because of that, a lot of the professors who do still practice have a greater influence on students. Do I have a solution for how to do that right now? Definitely not, but I might have some ideas in the future.
Our profession needs those of us who want to educate, no matter what your current qualifications or other professional aspirations may be. And the next generation of clinicians need us too.
Samantha (Sam) Puller, SPT, is a student at Virginia Commonwealth University. She is passionate about pediatrics and physical therapy education. You can connect with her via email.