Hello all

The New Quality Standards put in place by ABPTRFE on January 1, 2019 have caused serious problems for the manual therapy programs. In this post I will explain in plain language what is actually going on and why this is such an important issue for you to be aware of.  In an effort to update you on the current affairs, I have put together the information in the below text.Thank you very much for taking the time to read this. I strongly feel that we, as Fellows and Fellows in Training, should stay up to date with the current state of affairs and even if you do not think that this will affect you personally. Please realize that is will affect your colleagues and our profession on the whole. I strongly urge you to let your voice be heard and appreciate your support.

One of the issues is the number of mentor hours. ABPTRFE has changed the rules to only require 75 hours ofcontact hours for completion of the Fellowship Program. If we lower the standards to 75 hours, we will not be in compliance with the standards that the international federation of orthopedic manual physical therapy has set (IFOMPT standards) which require 150 contact hours. This is in complete violation of the original intention of AAOMPT. We need ABPTRFE to understand that the reputation of AAOMPT is strongly grounded in the historical recognition that a Fellow of any subsidiary of IFOMPT has completed a training that aligns that Fellow with the standards of all Manual Therapy Fellows internationally. Otherwise, a Fellow obtained in the US is not equal to that of a Fellow trained in another country.

We strongly believe that this will greatly water down the quality of Fellows and diminish the public’s recognition of the advanced level of clinical practice, which a FAAOMPT offers.  We also believe this will dilute the term “Master Clinician” which we believe describes all those who have graduated from MTI’s Fellowship program.

An additional problem is that if we move to the 75 hours standard, we will in essence create a dual fellow pool – those who are recognized by ABPTRFE, but not recognized by AAOMPT/IFOMPT. Our professional identity is already poor as it is, and to have this additional asterisk thrown in the mix will make the situation even worse.

Another issue is the standard of admission. Currently, in an attempt to create a standard for admission into all Fellowship programs, ABPTRFE has changed the admission requirements to be satisfied ONLY by completion of an APTA accredited Residency or the passing of a specialization exam.  Neither of these can prepare someone for the Manual Therapy Fellowship.

This new standard will do away with the option of getting into a fellowship program by demonstration of sufficient skill/experience in their chosen specialization.

Since MTI’s inception in 1998, it has graduated 390 Fellows, which is approximately 25% of all Fellows in the AAOMPT. Of these graduates, only 12 have entered the Fellowship program as graduates from an Orthopedic Residency Program. The remaining 378 entered the program by demonstration of sufficient experience in their chosen field of practice. In addition, we do not allow students with just an OCS to enter MTI’s fellowship program. Their psychomotor skills and advanced problem-solving skills are simply insufficient to qualify for entry in MTI’s Fellowship Program.

The majority of MTI students come in the fellowship program through demonstration of sufficient skill/experience in orthopedic PT.

This is achieved through a stringently structured pre-fellowship program, culminating in a written and practical exam to ascertain they have the requisite level of knowledge, problem solving- and psychomotor skills to succeed in the Fellowship program. This approach works and should stay in place.

Taking this option out puts the economic viability of MTI and other Fellowship programs at risk. For us specifically, instead of 390 graduates in 20 years we would only have 12. The company would not survive as an independent entity on the tuition of 12 students in 19 years. We would cease to exist as a fellowship program, which means there would be 25% fewer Fellows that graduate nationwide on an annual basis. For a professional organization like the APTA this cannot be a viable option. Our goal should be more Fellows, not less. Programs like MTI, EIM and NAIOMT, that by their specific design, are able to graduate more than the usual handful of Fellows a year, should be encouraged and promoted, not curtailed in their effort to advance our profession.

The newly proposed admission guidelines also puts an additional financial burden on prospective Fellows-in-Training. Student loan debt of new grads is already a significant problem and this will only increase over the coming years.  Residency training roughly costs $15,000 and Fellowship training another $16,000. This adds a hefty $31,000.00 tab in tuition payment alone, and that does not include the cost of lost time at work for completion of supervised hours.  Becoming fellowship trained is becoming financially too burdensome, and no small reason why after 20 years of existence the AAOMPT only has approximately 1200 Fellows. For a country the size of the US, that is shameful. We should do everything in our power to significantly increase these numbers, as these are the therapists that are the clinical experts and portray the truly high standards that all PT’s should strive to reach. Putting additional limits on Fellowship training will negate all of that and will only ensure that Fellowship trained Manual Therapists remain on the fringe of our profession instead of being the standard bearer that every other orthopedic PT looks for as a shining example of what is truly possible in orthopedic physical therapy.

All Fellowship Programs adhere to very high standards and I have yet to see a graduate of any of the programs who is not worthy of the Fellow designation. To assume that only OCS/SCS – and Residency grads are worthy of Fellowship training is doing a grave disservice to the remaining therapists out there who currently can get admitted by completing a year of pre-fellowship training courses.

There is simply no evidence that a graduate from a residency program, or one who has passed the OCS is better prepared for entry in the Fellowship Program than someone who has passed a rigorous certification program which requires both a written and oral/practical exam

The option to enter a Fellowship Program through admission of evidence of sufficient experience in your chosen field of practice should remain in place. It does not decrease the worthiness of therapists to enter the Fellowship program, nor does it water down the standards of Fellowship training. This has never been proven, and is a solution to a problem that does not exist.   

And finally, they are also attempting to implement a change in the site visit requirement. They are proposing that the addition of 2 mentoring sites will trigger a site visit to every subsequent new mentoring site added.

MTI adds new mentoring sites on a regular basis. On an annual basis we average 10 new sites each year. We solely draw from MTI’s alumni base to pick our mentors, and are extremely judicious as to whom we pick. There are strict guidelines that need to be met before they get added on as mentors.

However, if adding more than 2 sites per year warrants a site visit for each subsequent new mentoring site, this becomes problematic. The most important concern is that we just don’t have the financial resources to make this work. The cost of the site visit is $550 per day. The $550 only covers the cost for the reviewer. However, the administrative cost to facilitate the visit, and the loss of a day’s worth of revenue of the clinical site needs to be factored in as well.

This rule change has not been explained properly. CAPTE does not have the same requirement for entry-level PT schools. Why is it so important that we need this implemented for Fellowship programs? The program has already been accredited, so what will be different at a different facility?

As in many of the previously implemented rules by ABPTRFE, this appears to be an answer to a problem that does not exist.

The rules changes implemented by ABPTRFE over the last few years have created a logistical nightmare for Fellowship Programs.  The administrative burden to run a program, especially a larger multi-site program, have grown exponentially, and have not contributed to a higher quality of Fellowship training, which should always be first and foremost when implementing changes in Standards.

Please let your opinion be heard. We need your support and your voice is important. Send your letters to the following people:

ABPTRFE BOD & Staff

■              Kendra Harrington – [email protected]

■              Linda Csiza, PT, DSc – Chair – [email protected]

■              Kim Curbow-Wilcox, PT, PhD – [email protected]

■              Arielle Giordano, PT, DPT – [email protected]

■              Noel Goodstadt, PT, DPT – [email protected]

■              Tamara Gravano, PT, DPT – [email protected]

■              Mark Weber, PT, PhD, ATC  –  [email protected]

■              Samantha Gubka, PT, DPT – AAOMPT Representative – [email protected]

CC List:

• Bill Boissonault – [email protected]

○      AAOMPT Staff – [email protected]

Best regards,

Pieter and Tim