Trouble is brewing in the land of physical therapy residencies and fellowships.
James Dunning, Director of the American Academy of Manipulative Therapy (AAMT), alleged in a Friday, February 16th tweet that the new standards set forth by the American Board of Physical Therapy Residency & Fellowship Education (ABPTRFE) are in violation of the Sherman Act.
It appears APTA & ABPTRFE’s new fellowship admission criteria violate Section 1 of the Sherman Act. The new admissions criteria are anti-competitive, not based on quantitative evidence, and will likely result in injury to AAOMPT fellowship programs and the public in general…. pic.twitter.com/awDJFpTiCw
— SMI James Dunning (@DrDunning) February 16, 2018
What are the new standards?
The American Board of Physical Therapy Residency & Fellowship Education (ABPTRFE) accredits physical therapy residencies and fellowships. As we reported in August 2017, ABPTRFE set forth new standards for fellowships last year. While many of the changes are benign, several of the recommendations are controversial, in particular the elimination of the third pathway to fellowship: the skills track.
Historically, there have been 3 pathways into fellowship:
- Via specialization–holding an OCS, NCS, etc
- Completing a residency
- Evidence of experience/skills
There are other changes to standards that are of concern, including the decrease in fellowship mentoring hours from 150 to 75 1:1 hours. This change would make fellowships noncompliant with the International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) standards.
The new standards were adopted by ABPTRFE on June 21, 2017 and went into effect on January 1st, 2018. Programs are expected to be compliant by January 1, 2019.
In October 2017, the American Academy of Orthopedic Manual Physical Therapists (AAOMPT) requested a delay in implementation of the standards, but ABPTRFE declined, stating, “We understand that this is a significant change to the admission criteria, but believe the change is warranted to uphold the quality of post professional fellowship education and aligns with best practices among professions as the formal pathway to professional growth and development.” According to an AAOMPT conducted survey, 77% of fellowship directors are opposed to the change.
A communication problem?
Tammy Burlis, chair of ABPTRFE, stated in an August interview with Talus:
“Our goal of ABPTRFE is to create an accreditation culture of collaboration and continuous improvement that will ultimately enhance patient care and support the overall goals of the physical therapy profession. We’re really wanting to do the right thing for the profession as well as all of the stakeholders, those being the residents and fellows, the program directors, and external stakeholders.”
This goal, however, seems at best a distant dream to fellowship directors. Pieter Kroon, director of fellowship for the Manual Therapy Institute, interviewed with Talus Media in August: “The problem is that the communication between ABPTRFE and especially the fellowship programs has been tenuous at best because they don’t ask much for our input, and decisions get handed down, without much forethought, it seems to us…There are some nasty consequences for fellowship programs.”
Currently the only way for residency and fellowship directors to interface with ABPTRFE is through the American Academy of Orthopedic Manual Physical Therapists (AAOMPT). There is no liaison to residency/fellowship programs on the ABPTRFE board.
AAMT is making its message crystal clear. In a letter partially shared to Twitter by James Dunning and provided in full toTalus Media, legal counsel for AAMT outlines the following complaints against ABPTRFE, and subsequently the APTA:
“It appears ABPTRFE and APTA have unlawfully conspired to adopt anticompetitive admission requirements that intentionally siphon physical therapists to APTA’s residency programs and lucrative standardized written tests and away from respected third party education programs (i.e. non-APTA sponsored and independent certifications in orthopaedic manual therapy that have been, and are currently, offered by various continuing education companies or third party institutions, e.g., MTC, COMT, Cert. SMT).”
How does this impact fellowship programs?
The AAMT program accepts more than half of its applicants through the skills track, and AAMT is not alone. According to Pieter Kroon, of 180 Manual Therapy Institute fellows over 5 years, only 5 were residency trained.
The AAMT program starts in April–in order for the next cohort of fellows to be in compliance, all will have to have completed a specialization or residency. Kroon also points out that the financial burden to pursue residency or specialization prior to fellowship can be significant: the orthopedic specialization exam cost for an APTA member costs $1,315 in fees, and occurs one time per year. Residency takes at least a year to complete, and residents pay tuition–or may take a pay cut.
The crux of AAMT’s argument lies here: the elimination of the third pathway essentially shunts applications into two pathways controlled by the APTA, and stifles competition. Dunning’s tweet and the letter refer to the Sherman Act, an antitrust act from the 1800s, which, according to the Federal Trade Commission, is a “comprehensive charter of economic liberty aimed at preserving free and unfettered competition as the rule of trade.” The letter further argues that eliminating this third pathway would be significantly damaging to AAMT–the majority of the applicant pool would be ineligible to apply, and the lost revenue would be significant. Peter Kroon also stated that his and many other fellowship programs would be unsustainable under the new admission standards:
“I think what the consequence will be is that many of the bigger fellowship programs will just fold…we would be out of business.”
AAMT has requested that APTA respond to their letter by March 7, 2018. This is just the tip of the iceberg for ABPTRFE issues; stay tuned for more updates.
ABPTRFE and APTA did not respond to requests for comment for this article.
Rachel Jermann, PT, DPT, founder and president of Talus Media, loves hunting for PT news and broadcasting it. Also, Ben & Jerry’s. Find her on Twitter here.
Ian MacMurdie, SPTA, CSCS, voted most likely to be watching CSPAN on a Friday night, loves policy, and a stout ginger beer. Follow him on Twitter here.