USA (Physical Therapy)

Original Editor - Jeremy Bryan

Top Contributors - Jeremy Bryan, Admin and Elaine Lonnemann  

Patient Access to Physical Therapy Services / Entry Point[edit | edit source]

In the United States there are two ways to gain access to Physical Therapy services, by referral of by direct access. By referral is the traditional method and it means that a physician, surgeon, dentist, nurse practitioner, or physician's assistant writes a prescription for Physical Therapy services. By direct access means going directly to a Physical Therapist without meeting with another clinician for a prescription.[1]

Currently, all fifty states, the District of Columbia, and the US Virgin Islands allow direct access in some form. Each specific state stipulates their own parameters of direct access.[2]

According to the American Physical Therapy Association, as of February of 2021, there were 20 states that allowed direct access with no parameters or restrictions, 27 states, along with the District of Columbia and the US Virgin Islands, that allowed direct access with some form of parameters or restrictions, and three states that allowed direct access only under specific circumstances.[2]

Therapist Preparation[edit | edit source]

In order to practice Physical Therapy in the United States, a license is required for each state where the Physical Therapist practices.[3]

In order to be granted a license, a candidate must:

Obtained a Doctor of Physical Therapy (DPT) degree from a Commission on Accreditation in Physical Therapy Education (CAPTE) accredited Physical Therapy program.[3]

OR

Have international Physical Therapy education reviewed and approved by an acceptable credentialing agency.[4]

AND

Pass the National Physical Therapy Examination (NPTE).[4]

AND

Meet any additional state specific requirements such as the passing of a rules and regulations examination.

Degree/Credentialing[edit | edit source]

Currently, the standard for Physical Therapy education in the United States is a Doctor of Physical Therapy (DPT) degree.[3]As of January 2016, only programs which confer a Doctor of Physical Therapy (DPT) degree can become CAPTE accredited.[5]

[6]

Because a Doctor of Physical Therapy (DPT) degree did not become the standard until 2016, it is still common to find Physical Therapists within the workforce with Masters or Bachelors level Physical Therapy educations.

Specialization[edit | edit source]

Physical Therapists can pursue further education through residencies, fellowships, and certifications.

Residencies and fellowships are accredited through the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE).[7]

Residencies

Residencies allow a Physical Therapist to gain further education and experience in a specific clinical area.

ABPTRFE accredited residencies currently include programs in the clinical areas of:[7]


Residencies can prepare a Physical Therapist to sit for board certification in a specific clinical area. Board certification is offered through the American Board of Physical Therapy Specialties in the following clinical areas:[8]


Fellowships

Fellowships offer further education in the clinical area for which a Physical Therapists has graduated from a residence program or has been board certified.

ABPTRFE accredited fellowships include programs in the following clinical areas:[7]

  • Sports Division 1
  • Upper Extremity Athlete
  • Performing Arts
  • Orthopaedic Manual Physical Therapy
  • Hand Therapy
  • Spine
  • Critical Care
  • Neonatology


Certifications

There are numerous certifications that a Physical Therapist can obtain, spanning many different areas of practice.

Below are some examples of common certifications:

  • CHT or Certified Hand Therapist - Hand Therapy Certification Commission
  • CLT or Certified Lymphedema Therapist - Lymphedema Association of North America


Professional Associations
[edit | edit source]

The American Physical Therapy Association (APTA) is the main professional association in the United States. The APTA is a membership organization with involvement in nearly every aspect of the Physical Therapy profession.

Some examples of what the APTA does include:

Care Settings[edit | edit source]

Physical Therapy patient care in the United States spans a wide range of settings and population ranging from critical illness to performance.

  • Critical Care - critically ill patients in the ICU setting
  • Acute Care - hospital patients admitted to various units
    • Orthopedics
    • Neurology
    • Neurosurgery
    • Oncology
    • Cardiology
    • Pulmonary Medicine
    • General Medicine
    • Transplant Medicine
  • Emergency Department - Assisting with triage as well as discharge vs admittance decisions
  • Post-Acute Rehab
    • Rehabilitation Hospital
    • Nursing Home/Skilled Nursing Facility
  • Outpatient
    • General
    • Sports
    • Orthopedics
    • Amputation Rehab
    • Neuro Rehab
    • Vestibular Rehab
    • Cardiac/Pulmonary Rehab
    • Lymphoedema Rehab
    • Workers Compensation
    • Work hardening
    • Ergonomics
  • Military - outpatient but closer to a primary care practitioner (Physical Therapists can prescribe certain medications in this setting)
  • Sports Performance - in house Physical Therapists working for professional sports teams, universities, or Olympic teams

Type of Health System/Payment Structure[edit | edit source]

The United States' healthcare system consisting of both private and government funded hospitals, clinics, and healthcare facilities, and it does not use one payment structure across all settings or populations.

Americans with commercial insurance follow the Bismarck model. This model is the traditional insurance model of healthcare where insurance premiums are paid to private insurance companies who then pay non-government or privately operated healthcare facilities for delivery of care.[9]

Americans who receive care through the Department of Veteran's Affairs follow the Beveridge model. This model constitutes healthcare which is provided by government operated healthcare facilities, which are funded through taxation.[9]

Americans who receive care through Medicare or Medicaid utilize the national health insurance model. With this model healthcare is provided through non-government or privately operated healthcare facilities, but the government pays for the delivery of care.[9]

Additionally, Americans can also choose to pay out of pocket for healthcare services, without going through insurance or the government.[9]

Resources[edit | edit source]

References[edit | edit source]

  1. American Physical Therapy Association. Understand Access to and Payment for Physical Therapy Services. Available from https://www.choosept.com/health-tips/understanding-payment-physical-therapy-services (accessed 20 Jan, 2023)
  2. 2.0 2.1 American Physical Therapy Association. Levels of Patient Access to Physical Therapist Services in the U.S. Available from https://www.choosept.com/globalassets/choosept/assets/pdf-downloadables/direct-access-by-state-map.pdf (accessed 20 Jan, 2023)
  3. 3.0 3.1 3.2 American Physical Therapy Association. Becoming a PT. Available from https://www.apta.org/your-career/careers-in-physical-therapy/becoming-a-pt (accessed on 20 Jan, 2023)
  4. 4.0 4.1 American Physical Therapy Association. About PT and PTA Licensure. Available at https://www.apta.org/your-practice/licensure/pt-and-pta-licensure (accessed on 20 Jan, 2023)
  5. American Physical Therapy Association. The Clinical Doctorate (or “DPT”) Becomes the Only Degree Conferred by CAPTE-Accredited Educational Institutions. Availible at https://centennial.apta.org/timeline/the-clinical-doctorate-or-dpt-becomes-the-only-degree-conferred-by-capte-accredited-educational-institutions/ (Accessed on 20 Jan, 2023)
  6. Tim Fraticelli - PTProgress. How Long Does it Take to Become a Physical Therapist. Available from: https://www.youtube.com/watch?v=RapOl-gk29k [last accessed 10/6/2018]
  7. 7.0 7.1 7.2 American Physical Therapy Association. For Physical Therapist Residency & Fellowship Participants or Prospective Participants. Available from https://abptrfe.apta.org/for-participants (Accessed on 28 Jan, 2023.
  8. American Physical Therapy Association. Specialist Certification. Available from https://www.apta.org/your-career/career-advancement/specialist-certification (Accessed on 28 Jan, 2023)
  9. 9.0 9.1 9.2 9.3 Evans A, Mcilvena L. GoodRx Health. 4 Types of Healthcare System Designs — and the Pros and Cons of Each. Available from https://www.goodrx.com/hcp/providers/healthcare-system-designs (Accessed on 30 Jan, 2023)