Will Mandatory Residencies Be the Future?

By Mark Shepherd, PT, DPT

Our profession has come a long way in the past 10 to 15 years. We have increased the quality and quantity of research investigating interventions within physical therapy, which has grown our workforce of evidence-based clinicians. Most notable has been the growth of post professional training within physical therapy. It seems that over the last 10 years residency and fellowship programs in all specialty areas have become more available. Recently, a task force created by the American Physical Therapy Association (APTA) to work on best practice in physical therapy clinical education recommended to the 2017 APTA House of Delegates that the profession consider the need for mandatory residency training following entry-level education.

At first glance, this is quite the charge, one that will drive our profession toward specialty care and advanced training similar to the medical model. However, is this the model of the future?

Interestingly, about five years ago I had the opportunity to take part in the Oxford Debate at APTA’s NEXT Conference (formerly known as “Annual Conference”). The topic of debate was mandatory residencies—I was arguing for this movement. Although the debate was meant to be informal and comical in nature, the audience indicated its position with a surge of the crowd toward the side of the room taking the opposing view. Much of the comments made by the audience surrounded the topic of student loans and not having enough time to know what specialty to choose. Nonetheless, here we stand again looking at the topic with more firepower behind it.

Regardless of one’s stance on the issue, we have to think about whether our profession is ready for this move. Currently, there don’t seem to be enough spots to accommodate the need if residencies become mandatory. Many programs can only accept several students due to the limitations of space and number of mentors available. Furthermore, some clinical sites see no value in residency training, and students may expect and be looking forward to getting increased wages following the completion of a residency program. These are all issues that need to be addressed for long-term sustainability of such a movement.

Private practices can play a large role in this shift, and owners will need to rethink how they provide clinical mentorship (and clinical education for that matter). We need to consider a different model of post professional clinical training that involves multiple students being mentored by a clinical specialist versus the traditional one-to-one ratio. This will allow the capacity for more residents to come to a given clinic. The mentor can then float and actively engage with residents throughout the clinic.

If residencies become mandatory, we must also consider how students might be placed at a given clinic. A matching process, similar to what occurs during the final year of medical school, would be a great approach to balance clinical interests as well as student interests—a true win-win situation.

Many of these points may sound futuristic, but in fact residencies are already occurring as you read this. Students from the doctorate of physical therapy program at South College in Tennessee go through a matching process for their final clinical rotations that can allow for matriculation into a residency position. The clinic now can develop a relationship with the student through an internship prior to a residency so that each stakeholder can make sure it is the right path. The door is open for students to decide whether they want to do a residency. Now clinics have the opportunity to start a new graduate directly into a residency where the graduate knows the environment, the documentation, clinical flow, and patient load, providing much value that traditionally does not occur. The two-year DPT model allows for less student financial chains as they contemplate residency training. I hope to see more programs considering this approach.

At this point in the physical therapy profession’s growth, one can see the value of residency training. As private practice owners and clinicians, we play a large role in the future of residency training. We need to look outside our profession and beyond the walls of our clinics to see the opportunities we have to move our profession forward.

Paul J Welk

Paul J. Welk, PT, JD, is a Private Practice Section member and an attorney with Tucker Arensberg where he frequently advises physical therapy private practices in the areas of corporate and health care law. He can be reached at pwelk@tuckerlaw.com.

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