This is the second installment in a series on residency and fellowship education; the changes they are undergoing, how those changes came about, and what it it all means for the future. You can check out the first installment here.
Four weeks ago, James Dunning of the American Academy of Manipulative Therapy (AAMT) released a letter from legal counsel, threatening legal action against the American Physical Therapy Association (APTA) over new standards set forth by the American Board of Physical Therapy Residency & Fellowship Education (APTA). The letter (released in full here) references actions taken by the American Academy of Orthopedic Manual Therapists (AAOMPT).
Dunning announced in a tweet last week that ABPTRFE has agreed to defer implementation of the new standards to 2020.
APTA has agreed to defer implementation of the new ABPTRFE admission criteria until 2020; however, APTA has yet to provide any QUANTITATIVE EVIDENCE to support why PTs must complete OCS multiple-choice test ($2385!) rather than "skills track" before entering an OMPT Fellowship pic.twitter.com/OATIwF7MfL
— SMI James Dunning (@DrDunning) March 17, 2018
Following these recent events of potential legal action towards the ABPTRFE there has been increased interest in understanding how all these alphabet soup organizations are related to each other. It’s time to decode the alphabet soup.
Let’s start with the APTA.
The American Physical Therapy Association. Founded in the 1920s by Mary McMillan, the APTA recently surpassed the 100,000 member mark. The APTA guides the direction of the profession through the creation of policy, advocacy, and collaboration with other healthcare associations. Members of the APTA are part of state associations and specialty sections, which guide the ship through the House of Delegates. The House of Delegates (~400 members, elected by their state associations to represent the needs of their state) elects the APTA Board of Directors.
Then there is AAOMPT.
The American Academy of Orthopedic Manual Physical Therapists was established in 1991. In an interview with Talus Media, Joe Farrell, first president of AAOMPT, states that the organization was founded with 3 goals in mind:
- Be recognized by the International Federation of Orthopedic Manipulative Physical Therapists.
- Have an external accrediting body for residencies and fellowship
- Create a community of orthopedic manual therapists to foster research and communication.
AAOMPT is not a section of the APTA, like the Orthopedics Section or the Academy of Pediatric PT, but it is recognized by APTA as the representative, voting body to the International Federation of Orthopedic Manipulative Therapists (to learn more about IFOMPT, check out our interview with current president Ken Olsen). AAOMPT originally sought recognition from APTA through the Orthopedics Section. Members of AAOMPT are typically orthopedic manual therapists, and fellows hold the designation FAAOMPT. APTA and AAOMPT operate under a memorandum of understanding (MOU). Most recently this partnership was formally renewed this past August 7, 2017.
What about ABPTRFE?
The American Board of Physical Therapy Residency and Fellowship Education has officially existed since 2009, but has actually been evolving since 1997. The original committee was called the Committee on Clinical Residency Credentialing. Officially the ABPTRFE is a Board appointed group of the APTA. The APTA Board of Directors appoints the ABPTRFE Board of Directors (of which there are 7 members). The ABPTRFE board appoints a 14 member Accreditation Services Council and a cadre of reviewers and site visitors known as the Accreditation Services Committee. ABPTRFE did not originally accredit orthopedic manual residencies and fellowships; in 2001, AAOMPT ceded their credentialing process to ABPTRFE. Now, ABPTRFE is responsible for accrediting all existing residencies and fellowships, regardless of area of practice.
ABPTRFE can be thought of as the Commission on Accreditation for Physical Therapy Education (CAPTE) of physical therapy residencies and fellowships. However, there are some immediate, stark differences:
- The first is as noted above: ABPTRFE is essentially a board work group. The APTA Board of Directors is responsible for appointing the ABPTRFE board of directors. CAPTE officials are elected by CAPTE members each year.
- CAPTE is recognized by the US Department of Education and the Council for Higher Education Accreditation. ABPTRFE has noted that a long term goal may be to seek this recognition at a national level, but is not currently recognized at this level.
- CAPTE was officially recognized by the House of Delegates (the policy making body for the APTA). ABPTRFE has garnered no such recognition; however, there is currently a motion sponsored by the APTA Board of Directors to formally recognize ABPTRFE as the accreditation agency of Residency and Fellowship Programs. You can find that conversation on the House of Delegates HUB community.
APTA oversees ABPTRFE through the appointing of board members, but there is a lack of documentation specifying exactly how ABPTRFE reports back to the board. ABPTRFE, in turn, oversees and accredits residency and fellowship programs across the country. Just as CAPTE interacts with DPT and PTA programs, ABPTRFE is responsible for site visits and reviews for accreditation. AAOMPT provides a community and the link to the international stage for orthopedic manual therapists, as well as providing a space for residency and fellowship directors of orthopedic manual physical therapy programs to provide feedback. Crosstalk between ABPTRFE and AAOMPT seems tenuous at best; ABPTRFE does have a board member who is the “AAOMPT liaison,” though fellowship directors have stated that this is not effective (see our interview with Pieter Kroon, fellowship director for the Manual Therapy Institute).
The Impact of this Interplay: Immediate and Future
Of all the organizations, the decisions made by ABPTRFE have the most immediate impact on residency and fellowship programs, including current and future residents and fellows, directors, and faculty. With a significant increase in the growth of residency and fellowship programs over the past 10 years, this effect is not small. Fellowship directors worry about the financial viability of their programs following the changes, and those who are considering fellowship beyond 2020 will have to consider the impact of taking a certification exam or completing a residency prior to applying for fellowship.
Additionally, actions taken now may have an exponential impact years down the road with the expected growth of residency and fellowship programs. In June of 2016, the Best Practices in Clinical Education Task Force recommended that the profession transition to mandatory residency. This would inherently require (among other significant changes) exponential growth of residency programs to accommodate all graduating physical therapists. The role of an accrediting body (currently ABPTRFE) would be pivotal. The recommendation has been forwarded to the Education Leadership Partnership, but not acted upon. With the recent threat of legal action, questions have arisen regarding the structure, adaptability, and responsibilities of ABPTRFE.
If James Dunning is correct and implementation of the Fellowship standards changes have been delayed until 2020 everyone has an additional year to figure out how they are going to work together.
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.