Re: Mandated recredentialing of PTs

[Guest guest]

In a message dated 10/6/98 3:08:57 PM Central Daylight Time,

swrehab@... writes:

There is no question we have and will continue to have an over supply of

Physical Therapist. K. brings up the issue of preserving quality in

this over supplied market. Could the answer to preserving the quality of

care and jobs lie in recredentialing for physical therapist? Should we as a

profession follow the initiative of physicians and mandate recredentialing

every seven to ten years?

With a tightening marketplace, the provider needs to focus on educating all

parties involved in the healthcare process. When I worked with a therapy

chain, our therapists were constantly trying to educate the Doctor's on the

difference between our clinic and our competitors. All therapists now need to

turn that education process toward their insurers and patients. Two or three

years ago I tried to negotiate a contract with United Healthcare (UGH!). The

person that I was trying to contract with knew all about how therapists treat,

since he had been employed in a hospital for six months. An outpatient rehab

provider, outpatient clinician and hospital therapists have subtle changes in

their treatment pattern. Hospital environment is the least (in terms of

reimbursement) and therefore, have altered their treatment pattern over the

years to leverage the therapist' time. Rehab and O/P providers haven't had to

deal with that type of environment as much. So keep in mind that there are

differences between you and your competitors and begin the education process

with your insurers and patients today!!!

By the way, most patient's don't understand the insurance game. It's amazing

how quickly patients will become a provider advocate when you explain to them

what is going on with their insurance company.

Jim Hall

Rehab Management Services

222 3rd Street SE, Suite 306

Cedar Rapids, IA 52401

319/365-6384

______________________________________________________________________

[Guest guest]

At 03:17 PM 10/4/98 EDT, you wrote:

> There is no question we have and will continue to have an over supply of

>Physical Therapist. K. brings up the issue of preserving quality in

>this over supplied market. Could the answer to preserving the quality of

care

>and jobs lie in recredentialing for physical therapist? Should we as a

>profession follow the initiative of physicians and mandate recredentialing

>every seven to ten years?

>

I think that " encouraging " PTs to actively pursue continuing education on a

regular basis is an excellent idea.

The Manipulative Physiotherapists Associaton of Australia (MPAA) has such a

requirement in place, where, in order to maintain your membership of the

MPAA, a certain number of continuing education points must be earned within

a certain period of time. It used to be 5 points per four year period but

the system was beefed up a little in response to the membership feeling it

was a little too easy to attain.

Imagine if US PTs had to sit some sort of recredentialling exam or go

through some such process in order to maintain their licensure and right to

practice. Wow... we'd have quite a proactive and up-to-date bunch of US PTs

wouldn't we? I'd love it! How can we initiate such an idea?

Sincerely,

Louie Puentedura, GDMT, PT, OCS

Yuma, AZ

______________________________________________________________________

[Guest guest]

Dear colleagues....

I have long been in favor of mandatory continuing education......and have

heard the arguements against this. To have to defend why we DON'T require

continuing education, at a minimum, is impossible. My brand new students

think this situation is a travesty. As a profession, we seem to want more

responsibility and more autonomy, but not necessarily the accountability.

To affect continuing education and credentialing we must work at an

individual state level. In California, our vision statement specifically

mentions a move to re-credentialing that is part of a move towards making a

diagnosis. I hope more states are considering similar type moves. It has

been disconcerting to me as I have given continuing education courses

around the country to find people attending their first course and yet have

been practicing 20 years! So much has changed, and will continue to

change, that keeping up is imperative, although a struggle! Hopefully with

the coming of the information age, alternatives to " live - in person " type

education will be readily available.

Meanwhile......lets encourage our states to take the bold, but perhaps

unpopular move to require accountability from each of us and at a minimum

require CEUS. There are many ways of regulating this....from an honor

system to a reporting system and most professions are doing it. We could

also consider other evidence of professional learning such as teaching,

publishing, researching, home study, etc. We have no real excuses,

especially from our patient's perspective.

Dale Avers

At 01:13 PM 10/6/98 -0700, you wrote:

>At 03:17 PM 10/4/98 EDT, you wrote:

>> There is no question we have and will continue to have an over supply of

>>Physical Therapist. K. brings up the issue of preserving quality in

>>this over supplied market. Could the answer to preserving the quality of

>care

>>and jobs lie in recredentialing for physical therapist? Should we as a

>>profession follow the initiative of physicians and mandate recredentialing

>>every seven to ten years?

>>

>

>I think that " encouraging " PTs to actively pursue continuing education on a

>regular basis is an excellent idea.

>

>The Manipulative Physiotherapists Associaton of Australia (MPAA) has such a

>requirement in place, where, in order to maintain your membership of the

>MPAA, a certain number of continuing education points must be earned within

>a certain period of time. It used to be 5 points per four year period but

>the system was beefed up a little in response to the membership feeling it

>was a little too easy to attain.

>

>Imagine if US PTs had to sit some sort of recredentialling exam or go

>through some such process in order to maintain their licensure and right to

>practice. Wow... we'd have quite a proactive and up-to-date bunch of US PTs

>wouldn't we? I'd love it! How can we initiate such an idea?

>

>Sincerely,

>

>Louie Puentedura, GDMT, PT, OCS

>Yuma, AZ

>

>______________________________________________________________________

>

>

[Guest guest]

Personally I've had over 70 this year alone. The benefits of being single and

enjoying my work I guess.

Wow!! how do you get all those courses paid for??? Lucky you !! :-)

______________________________________________________________________

[Guest guest]

In Iowa, we are required to obtain 40 hours of continuing education every 2

years. PTA's are required to get 20 q. 2 years.

>>> " Emilio Puentedura, PT, OCS " 10/06 3:13 PM >>>

At 03:17 PM 10/4/98 EDT, you wrote:

> There is no question we have and will continue to have an over supply of

>Physical Therapist. K. brings up the issue of preserving quality in

>this over supplied market. Could the answer to preserving the quality of

care

>and jobs lie in recredentialing for physical therapist? Should we as a

>profession follow the initiative of physicians and mandate recredentialing

>every seven to ten years?

>

I think that " encouraging " PTs to actively pursue continuing education on a

regular basis is an excellent idea.

The Manipulative Physiotherapists Associaton of Australia (MPAA) has such a

requirement in place, where, in order to maintain your membership of the

MPAA, a certain number of continuing education points must be earned within

a certain period of time. It used to be 5 points per four year period but

the system was beefed up a little in response to the membership feeling it

was a little too easy to attain.

Imagine if US PTs had to sit some sort of recredentialling exam or go

through some such process in order to maintain their licensure and right to

practice. Wow... we'd have quite a proactive and up-to-date bunch of US PTs

wouldn't we? I'd love it! How can we initiate such an idea?

Sincerely,

Louie Puentedura, GDMT, PT, OCS

Yuma, AZ

______________________________________________________________________

[Guest guest]

I practice part time under the practice act of Oklahoma, where there is a requirement for 10 contact hours per year (20 per two year technically) that is enforced by random audit. I think that's working out fine, and 10 per year isn't such a bad number. Personally I've had over 70 this year alone. The benefits of being single and enjoying my work I guess.

Guy

Re: Mandated recredentialing of PTsDear colleagues....I have long been in favor of mandatory continuing education......and haveheard the arguements against this. To have to defend why we DON'T requirecontinuing education, at a minimum, is impossible. My brand new studentsthink this situation is a travesty. As a profession, we seem to want moreresponsibility and more autonomy, but not necessarily the accountability. To affect continuing education and credentialing we must work at anindividual state level. In California, our vision statement specificallymentions a move to re-credentialing that is part of a move towards making adiagnosis. I hope more states are considering similar type moves. It hasbeen disconcerting to me as I have given continuing education coursesaround the country to find people attending their first course and yet havebeen practicing 20 years! So much has changed, and will continue tochange, that keeping up is imperative, although a struggle! Hopefully withthe coming of the information age, alternatives to " live - in person " typeeducation will be readily available. Meanwhile......lets encourage our states to take the bold, but perhapsunpopular move to require accountability from each of us and at a minimumrequire CEUS. There are many ways of regulating this....from an honorsystem to a reporting system and most professions are doing it. We couldalso consider other evidence of professional learning such as teaching,publishing, researching, home study, etc. We have no real excuses,especially from our patient's perspective.Dale AversAt 01:13 PM 10/6/98 -0700, you wrote:>At 03:17 PM 10/4/98 EDT, you wrote:>> There is no question we have and will continue to have an over supply of>>Physical Therapist. K. brings up the issue of preserving quality in>>this over supplied market. Could the answer to preserving the quality of>care>>and jobs lie in recredentialing for physical therapist? Should we as a>>profession follow the initiative of physicians and mandate recredentialing>>every seven to ten years? >>>>I think that " encouraging " PTs to actively pursue continuing education on a>regular basis is an excellent idea.>>The Manipulative Physiotherapists Associaton of Australia (MPAA) has such a>requirement in place, where, in order to maintain your membership of the>MPAA, a certain number of continuing education points must be earned within>a certain period of time. It used to be 5 points per four year period but>the system was beefed up a little in response to the membership feeling it>was a little too easy to attain.>>Imagine if US PTs had to sit some sort of recredentialling exam or go>through some such process in order to maintain their licensure and right to>practice. Wow... we'd have quite a proactive and up-to-date bunch of US PTs>wouldn't we? I'd love it! How can we initiate such an idea?>>Sincerely,>>Louie Puentedura, GDMT, PT, OCS>Yuma, AZ>>______________________________________________________________________>>

[Guest guest]

>In Iowa, we are required to obtain 40 hours of >continuing education every 2

years. PTA's are >required to get 20 q. 2 years.

>

Texas requires 30 hrs. Q 2 years, and 15 for PTAs. I thought most states had

minimum CEU requirements for relicensure. I have absolutely no problem with

that- I have even had prospective employers compliment me on my choice of cont.

ed. courses. But sit again for the state board exam- 24 years later? No, thanks.

Most of what I have to offer my patients and coworkers is the intangible-

experience, maturity, decision making, instinctive kinds of things. Those aren't

exactly testable... Require re-exam, and I'm " outta here, " and onto a second

career....Guess that sounds like a cop-out, but why do we have competancy

requirements? They aren't enough? Or does no one enforce them?

> ______________________________________________________________________

>

>

[Guest guest]

At 01:53 AM 10/7/98 -0000, you wrote:

But sit again for the state board exam- 24 years later? No, thanks. Most of

what I have to offer my patients and coworkers is the intangible-

experience, maturity, decision making, instinctive kinds of things. Those

aren't exactly testable... Require re-exam, and I'm " outta here, " and onto

a second career....Guess that sounds like a cop-out, but why do we have

competancy requirements? They aren't enough? Or does no one enforce them?

This is exactly what I had to do when I came over here from Australia....

sit National board exams after almost 20 years since graduation. Guess

what? In the end it was a piece of cake!

The challenge was very stimulating and I really got into the study big time

because I was terrified of failing and looking like a complete moron.

Moreover, I was also scared that I would lose my visa status and have to

give up the idea of staying here for a few years, and return back downunder

with my tail between my legs. The experience left me much the wiser and I'm

certain that there was a significant jump in my PT knowledge and clinical

skills. It was like a wake up call.

Why shouldn't all PTs be given the same opportunity? Because that is what

it would be... not a burden, but an opportunity. Attending CE courses and

racking up CEU hours is a bit of a cop out, I think.

Sincerely,

Louie Puentedura, GDMT, PT, OCS

Yuma, AZ

______________________________________________________________________

[Guest guest]

In a message dated 10/6/98 4:08:41 PM Eastern Daylight Time,

swrehab@... writes:

> Imagine if US PTs had to sit some sort of recredentialling exam or go

> through some such process in order to maintain their licensure and right to

> practice. Wow... we'd have quite a proactive and up-to-date bunch of US PTs

> wouldn't we? I'd love it! How can we initiate such an idea?

>

> Sincerely,

>

> Louie Puentedura, GDMT, PT, OCS

> Yuma, AZ

Physician Assistants have to sit for recertification every 6 years. They have

to take to entire exam each time. No slack given for specialization. Something

along those lines might be interesting for PT's as well. I'll join the

committee to put the re-licensing of PT's into practice!

Cheers,

Jane Bunting, PT

______________________________________________________________________

[Guest guest]

Please reveal which courses have had the largest impact on your practice.

For me: Mulligan, McKenzie & Sahrmann.

Thanks

Fern Striffler

----------

>

>

> Personally I've had over 70 this year alone. The benefits of being sin=

gle and

> enjoying my work I guess.

> Wow!! how do you get all those courses paid for??? Lucky you !! :-)

>

>

> It's called a paycheck! My part time job paid for half of one, and=

the

> Army sent me to one other, but it was run by the Army, so it didn't rea=

lly

> cost them anything. One other was hosted here at our hospital, and we =

used

> the payments of outsiders to defray most of our costs. Everything else=

comes

> out of the good ole checkbook. I view it as an investment. A well pic=

ked

> course can make a dramatic difference in clinical practice in only a =

few days.

> Does a ton for my self-esteem when I know I'm using the most effective

> treatments, and that confidence is picked up by my patients. The same =

goes

> for buying good textbooks. Both are relatively inexpensive, compared =

to the

> amount of money I make each year. Viewing it as a " percentage investme=

nt in

> my career " takes the sting out of writing the checks for tuition.

>

> Guy

>

>

> ______________________________________________________________________

>

>

[Guest guest]

Hm-m-m...

" Recredentialling " of PTs would be ONE way of eliminating many of them/us

(depending on the decade).

The initial microeconomic effect on our own industry might be to reduce the

number of PTs offering their services in the same marketplaces in which we

offer ours. That would drive the supply curve upward, at least temporarily.

Assuming constant demand, the remaining PTs might earn more.

Now, the unintended secondary consequences. How might society use all of

those " ex-PTs " ? We must assume that they are going to attempt to market

their skill sets in order to make a living. Might they be able to sell

services and a lot of experience without calling it " Physical Therapy " ?

Might that not present society with yet one more " alternative " to physical

therapy? (ATC, Rehab Nurse, Exercise Physiologist, Chest PT, Massage

" therapist " , Kinesiologist, ...and Ex-PT... and who else?)

Further, when most PTs were licensed, there was no provision for removing

their license by re-credentialling. They/we have received a " license " from

the state, which conveys certain rigfhts and responsibilities. It might

even be a violation of the 4th(?) Amendment which protects citizens from

having the state deprive them something which they've been granted, just

like a property right... All currently licensed therapists might,

therefore, be " grandfathered " into a perpetual right.

It might be easier to just close some large percentage of the PT schools.

Somehow, I think there would be a great deal of howling if either approach

were taken.

Let's just focus on delivering excellent value to our communities.

______________________________________________________________________

[Guest guest]

Guy,

I still say you're lucky! :-) Somehow , the 3 kids and all their stuff

just seem to get in the way of a lot of courses. :-( I agree with you, though,

it IS an investment in my career. The couple of courses I get to go to a year

mean a lot to me, and I think long and hard about which one I choose. I am

currently trying to decide between the GREAT seminar course " Geriatric

Othopedics " and a course on OASIS in Dallas next month... Feedback, anyone?

______________________________________________________________________

[Guest guest]

In regard to mandatory continuing education, there are some states that do

require continuing education for continued licensure. This is an excellent

method to require that all therapists find some interest in the field and

pursue additional education in it.

Unfortunately, this is a state mandated issue and needs to be addressed at the

state level. There also needs to be enough staffing, and watchdogging at the

state level. This may be one reason why the mandate has not been

overwhelmingly passed in the future. In addition, we as a profession, hope

that the desire to continuously update our skills is motivation enough to

utilize continuing education. Alas, it is not so in many cases.

Maybe this can be originated via APTA headquarters in some way?

______________________________________________________________________

[Guest guest]

We should not confuse rights with privileges. By attending school, earning a

degree and passing licensure examinations, we earn the privilege to practice

physical therapy. It is not a right granted by a state or a government.

Rights can't be taken away by malpractice attorneys, but privileges certainly

can.

The compromise reached by physicians is that, when recredentialing began

existing physicians were grand fathered in and newer physicians must be

recredentialed.

The average physical therapist graduates in their twenties and could practice

approximately forty years before retirement. What assurances do patients (ie.

communities) have that they are being by provided the best quality treatment

by these therapist who graduated forty years ago?

State granted or approved CEUs are not sufficient. What about therapist that

move across state lines?

I sat for a board certification exam 21 years after graduation. I'm glad I

did. I agree with Louie from Australia, exam taking can be the best learning

experience of all.

______________________________________________________________________

[Guest guest]

Personally I've had over 70 this year alone. The benefits of being single andenjoying my work I guess. Wow!! how do you get all those courses paid for??? Lucky you !! :-)

It's called a paycheck! My part time job paid for half of one, and the Army sent me to one other, but it was run by the Army, so it didn't really cost them anything. One other was hosted here at our hospital, and we used the payments of outsiders to defray most of our costs. Everything else comes out of the good ole checkbook. I view it as an investment. A well picked course can make a dramatic difference in clinical practice in only a few days. Does a ton for my self-esteem when I know I'm using the most effective treatments, and that confidence is picked up by my patients. The same goes for buying good textbooks. Both are relatively inexpensive, compared to the amount of money I make each year. Viewing it as a " percentage investment in my career " takes the sting out of writing the checks for tuition.

Guy

[Guest guest]

I agree with the view that PT's need to be recredentialed. I work in

Michigan where we do not have a requirement for ongoing continuing education

nor for retaking the licensure exam. Many therapists that I know haven't

taken any courses in years, don't read journals, and certainly wouldn't

consider buying a textbook. The Michigan Physical Therapy Association has

made several attempts over the years at instituting mandatory educational

experiences (including a current attempt) but have been unable to do so by

the State regulatory agency! Without the state requirement to keep current

clearly come of my colleges make no attempt to do so.

In my setting I have fought hard with my administration to keep our CE

budget of $1,500 per therapist to cover tuition and housing (not

transportation).

- The most useful courses for me have been by Sahrmann, Gray and

Strategic Orthopedics Lumbar 1.

______________________________________________________________________

[Guest guest]

,

Thanks!! I knew the Carole course would be good. I needed some

input about the OASIS one. Carole ' course " Advanced Rehabilitative

Techniques for the Medically Complex Patient " is also wonderful. She gives

such a wealth of practical, useful information.

Now my decision is REALLY difficult!! I don't think the trip to Seattle

is in my future, unfortunately. :-(

______________________________________________________________________

[Guest guest]

Betsey:

Will throw my .02 into the ring -- I have taken the Geriatric

Orthopedics course with Carole and I HIGHLY recommend it. She is

absolutely the best lecturer I have had the pleasure of attending. You

would not be sorry to attend that one. Having said that -- the OASIS

course, which I believe is put on by Swaldo and Krulish should

also be a good one. I have attended several courses by them as well. They

are well organized and are officers in the Community Home Health Section,

so definately know what they are talking about. I will say that if you are

thinking about attending the Combined Sections meeting in February, they

will probably offer something similar there. The Combined Sections Meeting

is also money well spent and an incredible source of information. This

coming Feb it will be in Seattle. Hope that helps

Pike, PT, GCS

----------

> From: Betseyrpt@...

> To: ptmanageregroups

> Subject: Re: Mandated recredentialing of PTs

> Date: Wednesday, October 07, 1998 5:29 PM

>

> Guy,

> I still say you're lucky! :-) Somehow , the 3 kids and all their

stuff

> just seem to get in the way of a lot of courses. :-( I agree with you,

though,

> it IS an investment in my career. The couple of courses I get to go to a

year

> mean a lot to me, and I think long and hard about which one I choose. I

am

> currently trying to decide between the GREAT seminar course " Geriatric

> Othopedics " and a course on OASIS in Dallas next month... Feedback,

anyone?

> ______________________________________________________________________

>

>

[Guest guest]

M Lundy states:

>We should not confuse rights with privileges. By attending school, earning

a

>degree and passing licensure examinations, we earn the privilege to

practice

>physical therapy. It is not a right granted by a state or a government.

>Rights can't be taken away by malpractice attorneys, but privileges

certainly

>can.

I agree. While CEUs are not the answer (as was well articulated in other

posts), they contribute to ongoing improvement among attendees.

For the good of the profession (i.e. both its reputation and evolution) we

need to find ways to continually improve the quality of what is called

physical therapy. There are clinicians who have not continued their

education, either formally or informally, for many years. If we tolerate

colleagues who are not continuously improving their practices we could end

up in a position where others will step in to regulate the profession

physical therapy.

Jim

______________________________________________________________________

[Guest guest]

I agree that continuing education is vital and an absolute necessity to us as

individual practitioners and as a community of professionals.

Some years ago, I was a school board member in a small Texas county seat. We

were, at that time, in the midst of a debate on recredentialling public school

teachers, or basing their continuance on their " outcomes " -- the scores their

students might make on standardized tests. The legal counsel of the state

association of school boards advised us that a teaching certificate, once

issued,

actually became a " property right " and its holder could not be deprived of it by

the state board of education (licensing authority) without just compensation.

That's what prompted my earlier statement.

So, we have two issues: 1) The desirability of continuing education and, 2) The

ability of a state board of PT examiners to deprive someone of their license in

the absence of inapproporiate behavior. I'll bet that it varies widely from

state

to state. Nevertheless, I advocate for continuing professional education!

Of course, we might need to credential teachers of continuing education courses,

also!

$0.02

Dick Hillyer

______________________________________________________________________

[Guest guest]

There are many skills that are necessary to be a competent therapist.

Regurgitating information does not necessarily guarantee competence.

>>> 10/07 8:56 PM >>>

We should not confuse rights with privileges. By attending school, earning a

degree and passing licensure examinations, we earn the privilege to practice

physical therapy. It is not a right granted by a state or a government.

Rights can't be taken away by malpractice attorneys, but privileges certainly

can.

The compromise reached by physicians is that, when recredentialing began

existing physicians were grand fathered in and newer physicians must be

recredentialed.

The average physical therapist graduates in their twenties and could practice

approximately forty years before retirement. What assurances do patients (ie.

communities) have that they are being by provided the best quality treatment

by these therapist who graduated forty years ago?

State granted or approved CEUs are not sufficient. What about therapist that

move across state lines?

I sat for a board certification exam 21 years after graduation. I'm glad I

did. I agree with Louie from Australia, exam taking can be the best learning

experience of all.

______________________________________________________________________

[Guest guest]

Betsey:

Come on!!! Lets go to Seattle together!! I really can't afford it

either -- since I am unemployed (technically). But am seriously

considering it since I think that the information obtained is the very

latest and usually there are some really good pre-conference courses

offered by the different sections. Last year the Community Home Health

Section gave a pre-conference course that was very closely related to the

course they had given the November before. The Geriatrics section gave a

really good course on Falls in the elderly. You could kill several birds

with one stone....not to mention all of the freebies by the exhibitors ; )

--- let me know if you change your mind

Pike, PT, GCS

----------

> From: Betseyrpt@...

> To: ptmanageregroups

> Subject: Re: Mandated recredentialing of PTs

> Date: Thursday, October 08, 1998 4:12 AM

>

> ,

> Thanks!! I knew the Carole course would be good. I needed

some

> input about the OASIS one. Carole ' course " Advanced Rehabilitative

> Techniques for the Medically Complex Patient " is also wonderful. She

gives

> such a wealth of practical, useful information.

> Now my decision is REALLY difficult!! I don't think the trip to

Seattle

> is in my future, unfortunately. :-(

> ______________________________________________________________________

>

>