McMillan Lecturer Calls for Consolidation of PT Education Programs

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    To develop a fully mature academic enterprise in physical therapy, James Gordon, PT, EdD, FAPTA, called for fewer physical therapy programs. These programs, he said, should then consist of larger faculties committed to a tripartite academic mission of research, education, and clinical practice.

    The problem, he said in the 45th McMillan Lecture on June 12, lies with a proliferation of small, inadequately resourced schools that do not engage in research. He cautioned that the profession is "evolving a 2-tiered education system in physical therapy."

    A measure of an academic program should not be on class size, but on faculty size, he said, adding that almost half of all physical therapist programs have fewer than 10 core faculty. "There may have been a time in our history when a handful of teachers could impart the clinical and scientific wisdom necessary to go out and practice, but that time is over," Gordon said. "Physical therapy is a complex discipline; it requires a faculty with breadth of knowledge in a variety of clinical and scientific areas," he continued. "I would argue that simply to cover the basics in a physical therapist program’s curriculum, 10 core faculty members is an absolute minimum. And if we include the responsibilities associated with research, scholarship, and clinical practice, even 10 faculty members is probably not sufficient."

    Equally important in identifying a strong physical therapist program is the presence or absence of a research program. Gordon said his analysis of programs listed in CAPTE’s directory suggests only about half of them identify research or scholarship as part of their mission. Even then, he added, "These numbers undoubtedly paint too optimistic a picture. When we look more closely at the websites of the programs that profess a research mission, only about 75% of those actually highlight the faculty’s research on their websites."

    To those who would argue that programs can lack a research mission and still have strong teaching programs, he countered, "I would argue that this belief is incorrect … Our mission in professional education is not to prepare students for practice as it was carried out in the past or even as it is carried out in the present. Our mission is to educate our students for practice as it will be carried out in the future, 5 and 10 years from now. Only if we are actively engaged in creating that future can we be strong and effective teachers."

    Gordon acknowledged that programs with a strong research component cost more. But he compared the 2-tiered system to an unstable seesaw. "One side or the other will eventually become heavier, and the programs on the other side will slide toward the heavier side. On the nonresearch side, the principal force pushing down is cost pressure … In the current marketplace of higher education, it is difficult to imagine that programs with a research mission won’t find it more and more difficult to compete. The pressure to reduce tuition by cutting research will be difficult if not impossible to withstand … This is the way the free market works. Eventually, even programs with strong research, despite their superiority, cannot compete on price, and they will go away altogether," Gordon said.

    Gordon stressed that he recognizes the significant problem of college affordability, but "we must not try to solve this problem by ‘cheapening’ DPT education," he said. "We seriously misunderstand the problem if we view DPT education as job training or workforce supply. What we do in academic physical therapy … is not just communicate knowledge to students, not just train them in professional skills, but also create new knowledge and improve clinical skills."

    The solution, he said, is fewer programs with larger faculties. "Large programs with large faculties can achieve economies of scale that reduce costs," he explained.

    Gordon listed a number of other necessary steps to preserve quality physical therapist education programs. Among them:

    • "Institute a rigorous accreditation process for existing programs. CAPTE needs to work toward requiring all programs to measure a standard set of outcomes. It should apply faculty scholarship requirements strictly."
    • "We must raise the bar for new programs. Stop the bleeding. New programs are proliferating at an alarming rate, and the overwhelming majority have small faculties with little or no capacity for research and scholarship."
    • "We the APTA must put academic physical therapy at the top of our list of strategic priorities."

     

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