The Residency Model in Physical Therapy

Medical education in the United States changed forever 100 years ago.

In 1910, Abraham Flexner published a scathing report on the state of medical education in the US.  The now famous Flexner Report became a pivotal document paved the way for medical education to produce some of the worlds finest physicians.

One of the most notable aftershocks of the Flexner report came in the form of a wedge between the science-based medical community and fringe providers (including goldfish salesmen).  If you wanted to become a physician, you had to fall in line with modern medicine or you were out of the club.  Of course fringe providers still remained, but the reforms produced by the Flexner Report facilitated a culture of accountability that reduced the likelihood a goldfish salesman would ever get mixed up with a legitimate physician.

What’s interesting is that this process took an incredible amount of time to play out.  The Flexner Report was published approximately 60 years after the American Medical Association decided medical education was worth monitoring.  In 1900, the only thing you needed to become a physican was a high school diploma and four years of a medical school curriculum which had minimal standards for completion.  In 2000 you need competitive grades at a four year college, a strong MCAT, and participation in extracurricular activities.  And that’s just to be considered for entry!

While nowhere near the state of early 20th century medical education, the education of entry-level physical therapists is also undergoing fairly significant reform.  Like medicine, this change is happening slowly.

Or is it?  One of my most respected colleagues earned his certificate in physical therapy a little over 30 years ago.  We rapidly advanced to the BPT in the 80’s, had a temporary fling with the MPT in the 90’s, and now have achieved intergalactic oneness in the form of the DPT.  Yet despite the promise and flair the DPT brings, many feel the current educational model for physical therapy is not sufficient to meet the demands of modern clinical practice.

There is little doubt physical therapy education has never been better.  Students in DPT programs have a scope of knowledge ostensibly broader than their MPT or BPT colleagues, but is it good enough?  If it isn’t enough, what would be enough?

Let me answer the question with another:  Is four years of medical education enough to practice internal medicine?  Orthopedics?  Neurology?  Of course it isn’t and that’s precisely why residencies were born. Now no one in their right minds would go see an orthopedist or dermatologist unless he/she were board certified.

The medical profession transformed itself through residency and board certification with Flexner as the catalyst.  It’s time for us to undergo a similar evolution.

See you next week!!

Beck AH. The Flexner Report and the Standardization of American Medical Education. JAMA: The Journal of the American Medical Association. 2004;291(17):2139 -2140. 

About Roderick Henderson, PT, ScD

I am a board-certified orthopedic physical therapist and strength and conditioning specialist with a passion for delving deeper into our understanding of movement and how it affects our lives.

Posted on February 13, 2011, in editorial, education, PT students and tagged , , . Bookmark the permalink. 4 Comments.

  1. Great post Rod. I think as a profession this is a serious issue we need to look at. Obviously another part of the problem is that after all the schooling needed to accomplish the DPT and then residence, there are some pretty significant school loans usually built up. And with current salaries will the best students be willing to take on that amount of debt for what the payback in the end is? With residency and further specialization will the salaries follow?

  2. Interesting post. In theory it sounds good but like Kory mentioned adding this on to what is already required makes PT even less of an option. Why would someone choose a career that requires such an extensive initial investment with such a modest payoff? A career as a PA would become even more appealing. Would you think that if something like this were instituted PTA’s would become a bachelors program and take over a lot more responsibility?

    • Roderick Henderson, PT, OCS

      Thanks Scot. Physicians are facing the exact same problem. High initial investment in terms of both time and money. Couple this with diminishing payoff and there is little reason to consider becoming an MD. However, this hopefully won’t deter those who really want to be physicians from doing so.

      The argument that there is a cost-benefit risk to residency just doesn’t add up. One year of intensive training coupled with board-certification is likely to make the resident much more attractive to potential employers. AND it is one year at a reduced rate. It’s not a three year unpaid internship.

      Will it be hard? Yes. Is there a short term cost? Yes. But we simply cannot beg for direct access without upping our ante in the quest for clinical excellence. The DPT itself is as insufficent as the MD is for physicians. Hence the residency model is the most logical progression.

      • Dr. Brian R. Duncan

        The current state of health care is frustrating for many. Primary care physicians are overworked and underpaid ($150,000/year to start). On the other hand, many orthopaedic surgeons is the Texas Medical Center earn upwards of 800,000 per year. Many are invested in surgical centers, own their own MRIs, and hire out physical therapists. As in any field, the entrepreneurs, PCP or orthopod or physio, will always make the most green.

        As for residency training, it is a must if physical therapists want to be taken seriously by other health care professions and the public. Unfortunately, new grads are long on passion and short on role models. That passion is quickly lost or undermined with subpar clinical instructors, limited stimulating practices to join upon graduation, and even more limited mentors that are board-certified and/or fellowship-trained.

        Residencies change career trajectory for most participants. They are so unbelievably engaged in learning, teaching, and critical appraisal of practice patterns that they can’t help but be significantly different from their peers. This difference results in a bit more pay initially. However, long term it results in a far more stimulating career that opens many doors and does allow for a substantial return on investment (measure by $$$ and by personal satisfaction).

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