Dear Doctor of Physical Therapy (DPT) Administrators and University Leaders,
In March 2020, the Board of Directors for the American Council of Academic Physical Therapy (ACAPT) issued a letter to provide information about the changing landscape of physical therapist education and to encourage discussions about this at your institution. Much has transpired since the writing of that letter, and, as such, we are providing an updated version of the 2020 letter.
At present, there are 245 institutions supporting 261 accredited physical therapist (PT) education programs and there are 58 additional programs in some phase of development. ACAPT currently represents over 93% of accredited physical therapist (PT) education programs in the United States. Our mission is to support academic institutions to achieve excellence in physical therapist education. This quest includes developing future academic leaders, benchmarking hallmarks of excellence, providing meaningful and relevant professional development for faculty, supporting educational research, and seeking innovative models of clinical education.
As integral and critical members of the health care team, physical therapists have historically enjoyed high job satisfaction and high employment rates. The profession has been in high demand from consumers seeking services as evidenced by the United States Bureau of Labor Statistics (BLS) growth projections. The BLS has projected an 18% increase in the job outlook for physical therapists for 2019-2029.1 Consequently, there has been a strong applicant pool seeking placement in a PT program.
Over the past two decades, many universities have either increased class sizes of existing PT programs or started new PT programs. At the same time, however, reimbursement for physical therapy services has been a target of the federal government and third- party payers. In 2021, reimbursement from Medicare for PT, OT, and speech-language pathology services were cut approximately 3%. Health care cost containment has led to fewer reimbursable visits per episode and reduced reimbursement dollars per visit. Therefore, the actual rise in physical therapy employment is not likely to match BLS projections.
The most recent workforce study by the American Physical Therapy Association2 shows that projected increases in the national supply of PTs is outpacing expected growth in demand for services based on an increase in the U.S. population who have health insurance. Using data including current graduation, licensing, and attrition trends, the model predicts an estimated surplus of over 25,000 physical therapists by 2030.
Over the past 25 years, physical therapist education has transitioned from a baccalaureate to a masters to a doctoral degree, increasing PT knowledge/skills, but also increasing the time to degree completion and licensure and student loan debt. In short, the rate of increased student debt has outpaced the rate of PT salary growth. Research shows that for DPT graduates, a total debt load of more than $85K begins to put pressure on the value of a PT education. At $150,000 in debt or greater, the value falls below most other health care professions, and over $200,000, the debt-to-income ratio is unsustainable.3 The average PT graduate debt is presently over $120,000. Some prospective students, recognizing the gap between loan debt and salary potential, have turned away from the profession. Nationally, there has been a decrease in the number of Physical Therapy Centralized Application Service (PTCAS) applications over the past 3 years.4
Another challenge experienced by physical therapist education programs is a nationwide shortage of qualified faculty, with an average of 1-2 open faculty positions per program.3 Furthermore, accreditation requirements stipulate that at least 50% of program faculty must have a PhD or equivalent academic doctoral-degree, and all full-time faculty are required to have a defined scholarly agenda, including clinical or non-tenure track faculty.5 The result is that the demand for PT faculty with the necessary qualifications has outpaced the supply of qualified individuals.
Another critical consideration in PT education is the reality of clinical education. As a component of the curriculum, each program must provide students with multiple experiences within a physical therapy clinical setting.5 As PT programs require, on average, 34-36 weeks of full-time clinical experiences in the curriculum, the increase in numbers of programs has resulted in steadily increasing competition for clinical education sites.6 This competition has been even more amplified during the COVID-19 pandemic. Academic programs require an extensive network of clinical education sites and clinical instructors to provide adequate clinical education experiences for their students. As a consequence of the competition for programs, some clinical sites have limited the number of universities from which they will accept students to a small group of local/regional partners, while other clinics have begun to charge academic programs to place their students. The impact of these trends has been increased difficulty in placing students in required clinical experiences.
In light of all of these issues, the ACAPT Board of Directors has significant concerns about the state of PT education. The Board strongly urges academic administrators to seriously consider the current landscape of PT education before adding new physical therapist educational programs, expanding current class size, or increasing program tuition greater than the rate of inflation. Programs must be resourced with qualified faculty, space and equipment infrastructure, tuition commensurate with starting PT salaries of $65,000 per year, and an adequate depth and breadth of clinical education sites. Institutions with the available resources might consider how they can help meet the academic needs of individuals seeking a PhD or equivalent to increase the supply of PT faculty with academic doctoral degrees. Furthermore, the contribution margins for PT programs should be carefully scrutinized to ensure adequate financial resources exist for the program while maintaining reasonable tuition and fees.
In closing, we want to reiterate that careers in physical therapy are highly satisfying, and physical therapy students and faculty are an asset to any institution. ACAPT celebrates the excellence of successful academic PT programs and seeks to preserve and extend that success. We hope this summary of current issues leads to meaningful discussions at your institution regarding expansion or addition of DPT programs.
Sincerely,
The Board of Directors
American Council of Academic Physical Therapy (ACAPT)
References
1. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Physical Therapists.
2. Tepper D. Opportunities Exist in Projected Workforce Demand. APTA Magazine. April 1, 2021.
3. Shields RK, Dudley-Javoroski S. Physiotherapy education is a good financial investment, up to a certain level of student debt: an inter-professional economic analysis. J Physiother. 2018 Jul;64(3):183-191. doi: 10.1016/j.jphys.2018.05.009. Epub 2018 Jun 15.
4. 2019-2020 PTCAS Applicant Data Report. American Physical Therapy Association.
5. Commission on Accreditation of Physical Therapy Education (CAPTE). Aggregate program data: 2019–2020 Physical Therapist Education Programs Fact Sheets.
6. Commission on Accreditation of Physical Therapy Education (CAPTE). Accreditation Handbook, PT Standards and Required Elements.
7. ACAPT National Consortium of Clinical Educators (NCCE).