Physical Therapist Continuing Education Requirements

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This past week I was on an airplane reading some journal articles included in Mike Reinold’s “Shoulder Seminar” when the gentleman sitting next to me asked if I was still in school. (Yay for still looking young enough to be a student!) We discussed our careers and he explained that he is a home health nurse in Indiana where he is not required to do any continuing education.  Seriously?

I immediately shot off an email to a good friend who is a home health nurse in NY, soon to be in WA, and asked if she had the same requirements.  She told me that in NY State she also has no requirement, which she thinks is because of the administrative burden so many providers doing continuing education would cause on the state health department. As she’s preparing to relocate, however, she knows her requirements will change. Despite not having a requirement, she noted that she has participated in continuing education- some independently and some offered through her job. I didn't ask the gentleman on the plane if he did education even though it wasn't required - because I didn't think I'd like his answer.

This got me wondering about the requirements for continuing education as a Physical Therapist.  I have had a license in Connecticut and currently practice in Washington so I knew they both had requirements (that happen to be fairly similar).  My PT School classmates from UCONN are practicing in New Hampshire, Massachusetts, Rhode Island, New York, Colorado, and Texas (plus me in Washington).  For a class of sixteen people, we've spread out far and wide to be in seven different states! We're about to hit the four year mark out of school and I remember my friend who works in acute care in NYC telling me that she had no requirements for the first three years, but now does.  Thinking back to the past three years, I've probably averaged more than 75 hours per year of continuing education, far more than what was required of me, and can't imagine what it would be like to have not done all that work. 

I wanted to look at each state's requirements and was surprised to find that the APTA website links you to each state's practice act from which you could search for your specific requirements.  It makes sense that this would be the most up-to-date way to get the desired information, but I expected the APTA to have an easier way to look at the information.  Fortunately, WebPT has published a state by state list found here and published in December 2017.   I found several alternative lists of continuing education requirements for physical therapists such as this one from 2005 which only listed 29 states as having  requirements. That was a study examining practitioner opinion and healthcare outcomes along with continuing education and may have had an impact on states developing requirements.

 That paper outlined the following results:

1) "Of respondents from states without mandatory CE, 5.9% reported that they had not attended any CE over the preceding 5 years and 10.8% reported that they had attended, on average, 2 or fewer hours per year over the preceding 5 years"

2) Table 4 interestingly outlined that Washington State (where I live) Physical Therapists participate in 97% more continuing education than the required 40 hours every two years. 

3) "For the overall sample, respondents reporting membership in APTA participated in more CE than those who did not report membership in APTA."

4) "The overwhelming majority of all respondents, 96.2% (95.6% of therapists from states with a mandate and 97.2% of therapists from states without a mandate), believed that they improved as physical therapists from their participation in CE."

I went through WebPT's list and found that only Maine, Massachusetts, and South Dakota do not currently require continuing education for Physical Therapists. While each state varies, the average per year seemed to be between 10-20 hours of continuing education. Some states were very specific and others more vague regarding certain content and means of participation such as online versus in person course work. For example, in Washington, physical therapists must complete a three hour course for suicide prevention.  Many of the states also listed PTA requirements for continuing education which had a few more states that did not require hours.  

I wondered if any research has been done on the impact of continuing education requirements on patient outcomes. That search was a bit of a bust.  There were almost no articles that specifically examined physical therapists' education with patient outcomes. I did come across this paper which assessed patient outcomes following physical therapists completing a 2-day course for neck pain with minimal impact on their patients.  According to this 2010 paper from the Journal of the American Medical Association which looked at continuing education for physicians, the evidence for improving patient outcomes was not strong.  There isn't a strong body of evidence to support participation in continuing education, and what I could find showed minimal improvement in patient outcomes at best.  Both papers suggest that new ways of participating in continuing education may need to be developed and bigger sample sizes may also be beneficial.  More research on the topic is needed.

Regardless of these two papers, I'm not planning to stop my continuing education efforts any time soon.  I'll continue to pursue a variety of course topics and presentation methods including video presentations, in-person learning workshops and conferences, and self study, so that I can try to achieve optimal outcomes.  Also, in the future, when I'm the patient, I'm going to ask my providers what type of continuing education they've recently done because it shows a dedication to growth, and I want to be treated by practitioners who also value learning. Watch out Dr. Knudson - I'm asking you at my teeth cleaning next week!