Physiotherapy education is a good financial investment, up to a certain level of student debt: an inter-professional economic analysis

National Benchmarks to Understand How Doctor of Physical Therapy Learners From Minoritized Race and Ethnicity Groups Perceive Their Physical Therapist Education Program

OBJECTIVE

The demographic homogeneity of the physical therapist workforce and its educational pathway may undermine the profession's potential to improve the health of society. Building academic environments that support the development of all learners is fundamental to building a workforce to meet societal health care needs. The Benchmarking in Physical Therapy Education study uses the Physical Therapy Graduation Questionnaire to comprehensively assess learner perceptions of the physical therapist academic environment. The present report examined whether racial and ethnic minoritized (REM) physical therapist learners perceive their doctor of physical therapy education differently from their non-REM peers.

METHODS

Five thousand and eighty graduating doctor of physical therapy learners in 89 institutions provided demographic data and perceptions of a range of learning environment domains. Analyses included REM versus non-REM comparisons as well as comparisons among individual race and ethnicity groups.

RESULTS

Compared with their non-minoritized peers, REM respondents expressed less satisfaction with their education and lower confidence in their preparedness for entry-level practice. REM respondents observed more faculty professionalism disconnects and demonstrated less agreement that their program had fostered their overall psychological well-being. REM respondents experienced higher rates of mistreatment than their peers and reported higher rates of exhaustion and disengagement, the 2 axes of academic burnout. Black/African American and Hispanic/Latino/a/x (Hispanic, Latino, Latina, and/or Latinx) respondents incurred significantly more educational debt than Asian and White respondents. REM respondents reported greater empathy and greater interest in working in underserved communities.

CONCLUSION

REM respondents perceived the physical therapist learning environment more negatively than their non-minoritized peers but expressed strong interest in serving people from underserved communities. These national benchmarks offer academic institutions the opportunity to self-assess their own environment and to work to improve the quality of the educational experience for all learners.

IMPACT

In a nationwide benchmarking study, learners from minoritized race and ethnicity backgrounds reported more negative experiences and outcomes during physical therapist education than their non-minoritized peers. These same learners demonstrated high empathy and interest in serving people from underserved (under-resourced) communities. Learning environments that permit all individuals to thrive may be an essential avenue to improve the health of a rapidly diversifying society.

Socioeconomic Influence on Physical Therapist Student Financial Literacy, Self-Efficacy, Stress, and Anxiety

INTRODUCTION

Doctor of Physical Therapy (DPT) students have considerable educational debt upon graduation with suspected low levels of financial literacy, limited financial self-efficacy, and elevated stress and anxiety. The purpose of this study was to determine the relationships between financial knowledge, financial anxiety, financial stress, and financial self-efficacy with socioeconomic determinants in DPT students.

SUBJECTS

Five hundred seventy-eight DPT students, surveyed through a cross-sectional sample of convenience.

METHODS

Participants responded to a 40-item demographic questionnaire providing a self-assessment of their current financial literacy, financial self-efficacy, financial anxiety, financial stress, and level of general social support. Pairwise correlations were used to determine the relationship between independent variables and composite scores on self-assessment tools. Multiple regression analyses were conducted to predict financial knowledge, self-efficacy, anxiety, stress, and social support by socioeconomic indicators and educational debt status.

RESULTS

While there was a moderate, positive association between presence of debt and financial self-efficacy and financial anxiety for all students (r = .55), there was no statistically significant difference in financial knowledge, self-efficacy, anxiety, stress, or social support for students based on race/ethnicity. There was a negligible to weak correlation between financial knowledge, financial self-efficacy, and level of financial anxiety based on age, race/ethnicity, gender, socioeconomic background, debt load, risk tolerance, and retirement reflection. When subjected to multiple regression analysis, the level of education-related debt could explain a large proportion of the variance in multiple measures, including financial self-efficacy, anxiety, and stress. Economic background explained a large proportion of variance in the general social support students felt.

DISCUSSION AND CONCLUSION

We found a strong, positive correlation between the presence of debt and financial stress and anxiety for all DPT student respondents. While there is no difference in financial literacy and self-efficacy based on race and ethnic background, there is a moderate correlation between self-efficacy and financial anxiety for all students. Education on strategies to manage debt load may reduce both factors.

Influences of Financial and Workplace Factors on Physical Therapist Job Satisfaction

OBJECTIVE

The physical therapist labor market has recently noted higher rates of turnover and job vacancies. An understudied factor contributing to these trends in the profession is job satisfaction. The profession continues to experience relatively low wages compared with other health professions, and graduates of Doctor of Physical Therapy programs face increasingly high student debt. This study used the labor-search model as a conceptual framework to understand associations between job satisfaction, income, and educational debt. The purpose of this study is to observe the financial and workplace factors that are associated with higher levels of physical therapist job satisfaction.

METHODS

Data from 4764 physical therapists in 1 state were captured retrospectively through the state's licensure renewal process from 2014 to 2020. A random effects panel analysis, with job satisfaction as the dependent variable, was used to evaluate the relationships between job satisfaction and income, educational debt, and a variety of work-related factors.

RESULTS

Job satisfaction was negatively correlated with educational debt, number of hours worked per week, and some practice settings. Conversely, job satisfaction was positively correlated with the expected age of retirement. The percentage of time spent in research and administration was also positively correlated with job satisfaction, though additional research in this area is needed to draw meaningful conclusions on this association.

CONCLUSION

The results support the conceptual framework, which suggests that early career physical therapists, motivated by high amounts of educational debt, may choose more financially advantageous practice settings and increased working hours to the detriment of job satisfaction.

IMPACT

High levels of job satisfaction among physical therapists are correlated with low levels of educational debt, working 45 hours or less per week, a longer time horizon until retirement, and practice settings other than home health and skilled nursing facilities.

Healthcare educational debt in the united states: unequal economic impact within interprofessional team members

BACKGROUND

Advancing healthcare access and quality for underserved populations requires a diverse, culturally competent interprofessional workforce. However, high educational debt may influence career choice of healthcare professionals. In the United States, health professions lack insight into the maximum educational debt that can be supported by current entry-level salaries. The purpose of this interprofessional economic analysis was to examine whether average educational debt for US healthcare graduates is supportable by entry-level salaries. Additionally, the study explored whether trainees from minoritized backgrounds graduate with more educational debt than their peers in physical therapy.

METHODS

The study modeled maximum educational debt service ratios for 12 healthcare professions and 6 physician specialties, incorporating profession-specific estimates of entry-level salary, salary growth, national average debt, and 4 loan repayment scenarios offered by the US Department of Education Office of Student Financial Aid. Net present value (NPV) provided an estimate for lifetime "economic power" for the modeled careers. The study used a unique data source available from a single profession (physical therapy, N = 4,954) to examine whether educational debt thresholds based on the repayment model varied between minoritized groups and non-minoritized peers.

RESULTS

High salary physician specialties (e.g. obstetrics/gynecology, surgery) and professions without graduate debt (e.g. registered nurse) met debt ratio targets under any repayment plan. Professions with strong salary growth and moderate debt (e.g. physician assistant) required extended repayment plans but had high career NPV. Careers with low salary growth and high debt relative to salary (e.g. physical therapy) had career NPV at the lowest range of modeled professions. 29% of physical therapy students graduated with more debt than could be supported by entry-level salaries. Physical therapy students from minoritized groups graduated with 10-30% more debt than their non-minoritized peers.

CONCLUSIONS

Graduates from most healthcare professions required extended repayment plans (higher interest) to meet debt ratio benchmarks. For several healthcare professions, low debt relative to salary protected career NPV. Students from minoritized groups incurred higher debt than their peers in physical therapy.

Impacts of educational debt on physical therapist employment trends

BACKGROUND

Newly graduated physical therapists have high amounts of educational debt. Educational debt may negatively affect job satisfaction, aspirations for professional development, and choice of workplace setting. Research has not shown this association directly, yet it is conceptually supported by the Labor-Search Model. The purpose of this study was to understand the role that educational debt has on additional factors related to job choice in the Labor-Search Model.

METHODS

Retrospective data were captured through the Virginia Longitudinal Data System (VLDS) for 12,594 licensed physical therapists within the Commonwealth of Virginia from 2014 to 2020. A fixed effects panel analysis, with inflation-adjusted educational debt as the variable of interest, was conducted to assess whether patterns of professional certifications, volume of work, workplace setting, and job satisfaction were related to educational debt.

RESULTS

Educational debt was positively correlated with higher professional degrees (p = 0.009), the number of hours worked per week (p = 0.049), and expected number of years until retirement (p = 0.013). Job satisfaction was statistically significant (p = 0.042) and negatively correlated with educational debt.

CONCLUSIONS

Those with higher educational debt appear to have the habit of working more hours per week and have a longer time horizon until retirement. Newly licensed physical therapists with higher amounts of educational debt are more likely to experience this trend. Income and job satisfaction demonstrated an interaction effect on educational debt, such that those with lower levels of income had a stronger, negative relationship between their debt and job satisfaction, as compared to those with higher income.

Long-Term Career Earnings in Academia Might Offset the Opportunity Cost of Full-Time PhD and Postdoctoral Education for Physical Therapists Who Hold a Doctor of Physical Therapy Degree

OBJECTIVE

Rigorously trained physical therapy researchers are essential for the generation of knowledge that guides the profession. However, there is a current and projected dearth of physical therapy researchers capable of sustaining research programs in part due to perceived financial barriers associated with pursuit of a doctor of philosophy (PhD) degree, with and without postdoctoral training, following doctor of physical therapy (DPT) degree completion. This study aimed to evaluate the financial impact of PhD and postdoctoral training, including opportunity cost, years to break even, and long-term earnings.

METHODS

Clinical and academic salaries were obtained via the 2016 APTA Median Income of Physical Therapist Summary Report and 2019 CAPTE Annual Accreditation Report. Salaries were adjusted to total compensation to account for benefits and compared over a 30-year period starting after DPT education. Total compensations were also adjusted to the present value, placing greater weight on early career earnings due to inflation and potential investments.

RESULTS

Relative to work as a clinical physical therapist, 4 years of PhD training result in an earnings deficit of $264,854 rising to $357,065 after 2 years of additional postdoctoral training. These deficits do not persist as evidenced by a clinical physical therapist career earning $449,372 less than a nonmajority scholarship academic career (DPT to PhD to academia pathway) and $698,704 less than a majority scholarship academic career (DPT to PhD to postdoctoral training to academia pathway) over a 30-year period. Greater long-term earnings for PhD careers persist when adjusting to present value.

CONCLUSIONS

Although there is an initial opportunity cost of PhD and postdoctoral training represented by a relative earnings deficit, advanced research training results in greater long-term earnings.

IMPACT

The findings of this study allow physical therapists interested in pursuing PhD and postdoctoral training to be better informed about the associated financial ramifications.

Doctor of Physical Therapy Education in a Hybrid Learning Environment: A Case Report

OBJECTIVE

The purpose of this case report is to describe the implementation and report early outcomes of a 2-year (6-trimester), hybrid doctor of physical therapy (DPT) program.

METHODS

The case report describes management of (1) academic affairs, (2) student affairs, (3) faculty affairs, and (4) institutional affairs for an accredited, fully hybrid, 2-year DPT program. In the hybrid program, students from across the country participate in synchronous and asynchronous online learning and travel to campus twice per trimester for immersive blocks of in-person laboratory instruction. The case report describes how the program structures the hybrid learning environment and reports outcomes from the first 2 graduated cohorts.

RESULTS

Program outcomes assessment revealed that 97% to 98% of students/graduates reported being somewhat or very satisfied with the 2-year hybrid DPT program at the end of DPT year 1, at graduation, and at 1 year after graduation. Clinical instructors reported that 84% of students were prepared or well-prepared for clinical education. At 1 year after graduation, 20% of graduates were enrolled in or had completed residency, National Physical Therapy Examination (NPTE) pass rate was 97%, and employment rate was 99%.

CONCLUSION

Hybrid DPT education is feasible and may provide opportunities for more flexible and accessible delivery of DPT education. Outcomes of this case report suggest high student satisfaction, increased student/graduate diversity, and graduate outcomes comparable with national averages as reported in the Commission on Accreditation in Physical Therapy Education aggregate data.

IMPACT

This case report provides early evidence that hybrid DPT education-a type of blended learning that uses both face-to-face and online instructional strategies-is feasible, with student satisfaction and student/graduate outcomes comparable with national averages. Hybrid education may provide educators, programs, and institutions the flexibility to innovate in ways that address some of the immediate and long-term challenges facing physical therapist professional education while maintaining standards of excellence.

Benchmarking in Academic Physical Therapy Using the PT-GQ Survey: Wave 2 Update With Application to Accreditation Reporting

OBJECTIVE

The Benchmarking in Academic Physical Therapy study uses the Physical Therapist-Graduation Questionnaire (PT-GQ) survey to develop comprehensive performance benchmarks for physical therapist education. These benchmarks facilitate interprofessional comparisons and have application to accreditation self-study reporting. The purpose of this study is to report updated benchmarks from enrollment Wave 2 of the study, with an emphasis on curricular areas that align with accreditation standards.

METHODS

Seventy doctor of physical therapy (DPT) programs (26.5% national sample) administered the survey to graduates during 2020-2021. Where possible, respondent data were contextualized by statistical comparison with published medical student data (Welch t test, Hedges g).

RESULTS

There were 1894 respondents who participated in the study (response rate: 63.9%). The average survey duration was 32.9 minutes. White-only, non-Hispanic/Latino/a/x individuals (78.8%) exceeded the 2020 US Census prevalence (60.1%), and only one-half of respondents perceived a benefit to their training from the diversity present in their programs. Over 94% of respondents indicated that their curricula were characterized by "problem solving/critical thinking" and "clinical reasoning," but nearly one-half indicated "busywork" was prevalent. High curricular satisfaction ratings clustered in content areas relating to profession-specific technical skills and low ratings clustered in foundational sciences. DPT respondents reported significantly lower tolerance for ambiguity, significantly more exhaustion, and significantly less disengagement than medical students. Respondents endorsed higher levels of "adaptive" perfectionism (striving for high performance) than "maladaptive" perfectionism (concern over negative evaluations). Respondents with loans (27.7%) had debt exceeding $150,000, the benchmark above which the DPT degree loses economic power.

CONCLUSION

PT-GQ benchmarks revealed strengths (eg, curricula emphasizing problem solving/critical thinking and clinical reasoning) and challenges (eg, low diversity, problematic student debt) in physical therapist education.

IMPACT

Programs can use benchmarking for quality-improvement efforts and as a data source for accreditation self-study reports. The ongoing study will refine national benchmarks and pilot items to address new research questions.

Health Professions Educational Debt: Personal, Professional, and Psychological Impacts 5 Years Post-graduation

INTRODUCTION

Cost burden in health professions education is rising. To bridge the gap between growing tuition and stagnating wages, student loans are increasingly obtained to cover educational costs. The spiraling after-effects are a source of acute concern, raising alarms across institutions and occupations. There is little dissemination to date of feasible data collection strategies and outcomes beyond 1 year post-graduation. Research is needed in evaluating the impacts of healthcare educational debt on career and personal choices following transition to practice.

MATERIALS AND METHODS

This study utilized a cross-sectional, mixed methods design. Doctor of Physical Therapy (DPT) Program graduates 5 years following degree completion completed a quantitative online survey, with topics including debt-to-income ratio, educational debt repayment strategies, impact on personal factors, non-education debt, and perceived value of their health professions education. Subsequent phone interviews were conducted by student researchers to gain insights into alumni perceptions of the impacts of educational debt on personal and professional decision-making. Data analysis involved descriptive and correlational quantitative statistics and open and axial coding of interview constructs.

RESULTS

The mixed methods format was successful in obtaining desired depth of response data. Quantitative findings demonstrated primary factors impacted by educational debt as savings, housing, leisure, discretionary spending, and family planning. Qualitative findings revealed impacts on themes of "personal factors" (81%), "professional factors" (62.5%), and "psychological factors" (56%) 5 years after graduation. Most negatively impacted were housing decisions, hours worked, initial job selection, and ability to save for the future, contributing to decreased mental health wellbeing with anxiety, frustration, and guilt. The majority (75%) of respondents perceived a high degree of value during and following their DPT education, though many expressed discordance between expectations and realities of practice.

DISCUSSION

Findings demonstrate that impacts of health professional educational debt in professional, personal, and psychological factors continue 5 years following degree completion, regardless of debt load. Successful implementation of this pilot methodology indicates potential for use of such extended data collection strategies. Further research is needed at the programs, profession, and/or interprofessional level to garner depth of understanding to guide interventions designed to mitigate or prevent these long-term repercussions.

Digital Entry-Level Education in Physiotherapy: a Commentary to Inform Post-COVID-19 Future Directions

Currently, the coronavirus disease 2019 (COVID-19) severely influences physiotherapy education which is based mostly on face-to-face teaching. Thus, educators have been compelled to adapt their pedagogical approaches moving to digital education. In this commentary, we debate on digital education highlighting its effectiveness, the users' perspectives, and its weakness in the context of physiotherapy teaching aimed at informing post-COVID-19 future directions in this educational field. Existing evidence on digital education produced before COVID-19 supports its implementation into entry-level physiotherapy education. However, some challenges (e.g. social inequality and evaluation of students) threaten its applicability in post-COVID-19 era, calling educators to take appropriate actions.

Benchmarking in Academic Physical Therapy: A Multicenter Trial Using the PT-GQ Survey

OBJECTIVE

Academic physical therapy has no universal metrics by which educational programs can measure outcomes, limiting their ability to benchmark to their own historical performance, to peer institutions, or to other health care professions. The PT-Graduation Questionnaire (GQ) survey, adapted from the Association of American Medical Colleges' GQ, addresses this gap by offering both inter-professional insight and fine-scale assessment of physical therapist education. This study reports the first wave of findings from an ongoing multi-site trial of the PT-GQ among diverse academic physical therapy programs, including (1) benchmarks for academic physical therapy, and (2) a comparison of the physical therapist student experience to medical education benchmarks.

METHODS

Thirty-four doctor of physical therapy (DPT) programs (13.2% nationwide sample) administered the online survey to DPT graduates during the 2019 to 2020 academic year. PT-GQ and Association of American Medical Colleges data were contrasted via Welch's unequal-variance t test and Hedges g (effect size).

RESULTS

A total of 1025 respondents participated in the study (response rate: 63.9%). The average survey duration was 31.8 minutes. Overall educational satisfaction was comparable with medicine, and respondents identified areas of curricular strength (eg, anatomy) and weakness (eg, pharmacology). DPT respondents provided higher ratings of faculty professionalism than medicine, lower rates of student mistreatment, and a lesser impact of within-program diversity on their training. One-third of respondents were less than "satisfied" with student mental health services. DPT respondents reported significantly higher exhaustion but lower disengagement than medical students, along with lower tolerance for ambiguity. Of DPT respondents who reported educational debt, one-third reported debt exceeding $150,000, the threshold above which the DPT degree loses economic power.

CONCLUSIONS

These academic benchmarks, using the PT-GQ, provided insight into physical therapist education and identified differences between physical therapist and medical student perceptions.

IMPACT

This ongoing trial will establish a comprehensive set of benchmarks to better understand academic physical therapy outcomes.

National Study of Excellence in Pediatric Physical Therapy Education: Design, Methods, and Results

OBJECTIVE

The purposes of this study were to identify and describe the attributes of excellence and innovation in professional pediatric physical therapy education and develop a conceptual framework identifying dimensions of excellence.

METHODS

A multimethod case study design based on a grounded theory framework was used. Data collection included review of artifacts and field interviews (individual and focus group). A constant-comparative method for within case and across case was used for data analysis to verify and revise coding schemes, identify categories and subcategories, revise emerging themes, and develop a conceptual framework.

RESULTS

Based on results of a predetermined grading rubric, 6 of 17 self-nominated academic sites were selected representing diverse institution types (public/private, Carnegie classification, size) and geographic locations. Pedagogical approaches and method of content delivery varied among programs; all used the essential core competencies. The core pediatric faculty member(s) were Board Certified Clinical Specialists. A conceptual framework was developed based on 4 key dimensions: Culture of Excellence, Exemplary Pediatric Faculty, Pedagogy, and Child and Family as Teacher (CFT), and 16 related elements.

CONCLUSIONS

CFT is a unique and nonnegotiable dimension of excellence in pediatric physical therapy education, highlighting the partnership between the learner, child, family, and pediatric faculty member. CFT intersects with the other dimensions and integrates their elements (ie, faculty characteristics, contributions from the child and family, use of instructional strategies) to effectively prepare future pediatric physical therapists. Based on the pervasiveness of this dimension in teaching and learning across all programs, this may be the signature pedagogy of pediatric physical therapy education.

IMPACT

Results of this study are important to professional physical therapist education administrators, pediatric academic faculty, and clinical educators because they represent an understanding of the attributes of excellence. The model can serve as a guide for best practice in pediatric physical therapy education.

An orthopedic manual physical therapy fellowship training's impact on professional development, involvement, personal lives, and income - A survey study

Introduction: Little research exists investigating the personal and professional outcomes of postprofessional physical therapy (PT) training. Therefore, the purpose of the current descriptive, web-based survey study was to determine self-reported outcomes from a postprofessional PT fellowship program, including graduate professional, educational, and research involvement; perceptions of the impact of training on clinical and professional attributes; changes in employment and income; and barriers to training. Methods: Graduates of a part-time, hybrid-model, multisite orthopedic manual PT fellowship program were invited to complete the web-based survey. Descriptive data analyses were performed for all quantitative data, and responses to questions were analyzed and categorized into themes. Results: Of the 77 fellowship graduates, 75 (97%) completed the survey. Graduates were involved in teaching; 43% (32/75) filled lead instructor roles in PT education programs. Further, 75% (57/75) were involved in research. The mean (SD) and median (range) increase in annual gross income was $9560 ($17,545) and $2,500 ($0-$125,000), respectively. Perceived areas with the largest impact of training included clinical reasoning, patient-centered and evidence-based practice, and professionalism. Life balance and family commitments were frequent barriers during training. Discussion: Graduates noted substantial perceived professional, clinical, and financial benefits to fellowship training. Limitations included lack of a control group and surveying participants from a single program. Future research should determine the influence that program and participant-related factors have on personal and professional lives of graduates and on clinical outcomes. Level of Evidence: Descriptive survey, level 3.