The Cost of Completing a Physical Therapy Residency Program

Alan Fredendall // #LeadershipThursday // www.ptonice.com 

In today's episode of the PT on ICE Daily Show, ICE COO Alan Fredendall discusses the state of physical therapy in 2023 with regards to pay. In this episode, the question of whether pursuing a career in physical therapy is worth it is addressed. It acknowledges that individuals may have concerns about the return on investment for the time and money spent on education and training to become a physical therapist. Alan mentions that some may be discouraged by the long time it takes to see a return on their investment, as it can take 15 to 20 years to pay off the debt associated with advanced certifications or residencies.

To address this concern, Alan suggests the need for better guidance for future physical therapists in terms of education and career choices. He emphasizes the importance of providing information to students considering entering the profession, as well as those already in school or practicing as physical therapists. Alan suggests informing future PTs about alternative routes to becoming a physical therapist that may be quicker and more cost-effective, such as completing prerequisites at a community college and transferring to a four-year program if necessary.

The episode also highlights that not all PT schools require a bachelor's degree and that there are various paths to becoming a physical therapist. Alan suggests providing better guidance to students during observation hours or while they are still in high school or undergrad, to inform them about the available options and help them make informed decisions about their education and career paths. References

Take a listen to the podcast episode or read the full transcription below.

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EPISODE TRANSCRIPTION

00:00 INTRO Good morning, happy Thursday morning. Welcome to the PT on ICE Daily Show. I hope your morning is off to a great start. I'm happy to be here today as your host. My name is Alan. I currently have the pleasure of serving as the Chief Operating Officer here at ICE and a faculty member in our Fitness Athlete Division. Here on Thursdays we talk all things Leadership Thursday, small business ownership, practice management related to physical therapy, that sort of thing. Leadership Thursday also means it is Gut Check Thursday. Today's Gut Check Thursday is a little kind of cardio party, bodyweight only, combination of running and some bodyweight reps. So it starts off with descending distance. So we start with a thousand meter run and then we hit 25 burpees and then we hit an 800 meter run and then we hit 50 air squats and then we hit a 600 meter run and then we hit 75 walking lunges and then we finish with a 400 meter run. So just a little bit shy of a 3k run, about a mile and three quarters of running and then some bodyweight reps as well. Probably for most folks in the 20 to 30 minute time domain, certainly those of you who are faster runners and those of you who really want to push the pace can really get after the run and those bodyweight reps and really get your heart rate up. Or this is also a great workout even though it's Gut Check Thursday, if you're feeling beat up at this point in the week to just take those runs nice and easy, take those bodyweight reps nice and easy and kind of treat it more like an active recovery piece. So that's Gut Check Thursday for this week. Courses coming your way, we have a whole bunch of courses coming up in August, the weekend of August 5th and 6th. We have Paul down in Greenville, South Carolina for dry needling lower body and then we have Alex Germano in Frederick, Maryland for Older Adult Live. The next weekend August 12th and 13th, we have Lindsay Huey here in Michigan, Rochester Hills, Michigan for extremity management. We have the Older Adult Live Summit, that's going to be all of the older adult lead faculty and TAs at Stronger Life headquarters in Lexington, Kentucky. I'm going to that course, that's going to be a great weekend. We also have out on the west coast, Justin Dunaway for Total Spine Thrust out in Bellingham, Washington. The weekend of August 19th and 20th, Lindsay Huey is again on the road with extremity management, this time in Fremont, Nebraska, right outside of Omaha. Paul will again be on the road for dry needling, this time with lower body out in Phoenix, Arizona. And then two chances at Older Adult Live, either in Bedford, Texas right outside of Dallas or in Minnetonka, Minnesota. And in the last weekend of August, August 26th and 27th, cervical spine management will be at Onward Charlotte with Jordan Berry. Older Adult Live will be in Carpinteria, California, that's out on the west coast, just north of LA for Older Adult Live. And then again, Paul will be on the road for dry needling, this time upper body, same venue the next weekend in Phoenix. So we have back to back dry needling weekends at the same venue out at Exos in Phoenix. If you're looking to get both courses knocked out in a short amount of time, you can look at those courses at the end of August. So that's what's coming your way for courses. Again, everything related to ice can be found at ptniice.com. Today's topic, the state of physical therapy 2023. Now, you might be thinking, Alan, that sounds arrogant. Who are you to inform me on the current state of physical therapy in 2023? And before we get started, I just want to say this is coming directly from our national member organization, the American Physical Therapy Association. So if you're not aware right now, the House of Delegates is going on kind of the annual meetup of state delegates from every state meeting and discussing various policy related things to physical therapy, kind of like the Congress of American Physical Therapy. And today's topic is really focused on what was announced related to both pay and residency from APTA. This was at the end of last week. So they released a publication, a series of infographics called the state of physical therapy in 2023. They talked about PT pay over the past about two decades, the past 20 years, they talked about the state of physical therapy, residency and board certification. And probably most importantly, for the first time, really ever, they released some concrete data on pay related to going through a residency and obtaining a board certification, how much extra money can you expect to make. So let's start first with the pay of it's interesting that this was released, because it doesn't bode well for physical therapy that the the information released by APTA shows pay changes from 2004 to 2021. So about a 17 year change, showing that the national average for pay in 2004 was about $68,000, and that it is now about $91,000 in 2021. They also released a breakdown based on geographical region showing a little bit more geographical specific information, especially as it relates to cost of living. But they summarize it all average it all out for that national average. Now you might be thinking Alan, that sounds great, man. 68,000 to 91,000 is significant. That's almost a $30,000 increase. But we have to step back and say, that's not how money works. That's not how economics works. That's not how math works. That if we track money across 17 years, we have to of course, adjust for inflation. And then if we do indeed adjust for inflation from 2004 to 2021, then if we were making an average of 68,000 in 2004, we should be making over $110,000 in 2021. Now, we know inflation has been crazy the past couple years. So it's probably going to be even above 110,000. But we know based on the data released that we are not meeting inflation, which is to say that nationwide on average, across the country, physical therapy pay has been flat or even negative for about the past 20 years, which is a little bit concerning that we have had so many years of essentially flat pay. Based on forecasting from 2021 forward, if we keep this same trend, physical therapist average pay in 2030 should be $135,000 a year. Now, I don't know about you, but I'm not going to hold my breath on that. I don't think it will ever get that high, even in higher cost of living areas. So that my first point is the state of pay is quite concerning that our pay in general is flat or maybe even adjusting for inflation a little bit negative. And that's something we need to be concerned about both is employees and employers of what steps can we take to reduce costs so that we can continue to improve pay and continue to at least match pay based on inflation with the folks that are working on our teams with us. On the employee side of things, this should be concerning to you because if you are below this, this means you're even more flat or possibly even more negative than the national average of if you are not getting a raise every year that is at least in line with inflation, you are technically losing money. The cost of everything in your life that costs money is more expensive. If your pay is not matching that, then you are slowly losing ground financially. So we need to know the state of physical therapy in 2023 is that pay seems to be flat, which is concerning. The second data point, the second infographic released by APTA listed out board certification specialties based on a percentage of physical therapists who hold that board certification. We know that there are 26,308 physical therapists who are board certified out of about a licensed population of 300,000 or so. The vast majority of folks who hold board certification hold a board certification in orthopedics. Almost 60% of those 26,000 people have a certification orthopedics. So right away you should be thinking, wow, very saturated market right of pursuing that OCS of pursuing that residency and board certification orthopedics is really not going to make you stand out that much when the vast majority of people who are board certified are already board certified in orthopedics. After orthopedics board certification really kind of falls off a cliff. 13% of board certified physical therapists hold board certification with their NCS in neurological physical therapy. 10% have their GCS in geriatric physical therapy. 9% are sports certified, hold their SCS. 7% pediatric certified with the PCS. Only 2% women's health certified with the WCS. And then it really falls off a cliff even more. 1% of those folks who have board certification have a cardiopulmonary board certification, the CCS, and then about half a percent each for clinical electrophysiology, the ECS, and half a percent for the OPT, the oncological physical therapy specialty. So you should know where most of us work in outpatient orthopedics is already saturated market and it's even saturated with board certification. So just know if you're thinking in your mind, man, I want to do that orthopedic residency. Man, I really want to go get that OCS. It's really going to make me stand out. You should think again based on this data. Again, based on flat pay, based on the market saturation, you should be thinking twice before you think OCS is really going to make me stand out among orthopedic clinicians. Not really, right? A lot of people already have it. That gets into my third point of what pay increase can you expect for going through your residency obtaining your board certification? This is a question many people have and now thanks to APTA we have some concrete data on it. The short answer is you shouldn't expect much of a pay increase at all. An average of $2.27 more per hour for having a board certification or about $3,500 more per year after taxes. You should know the pay bump based on certification varies greatly. When we pull back from that average and look at those individual board certifications, what stands out? Clinical electrophysiology stands out a lot. Those folks make about $27 more per hour. We know that's a very subspecialized area of physical therapy where most people don't work. Only about 100 people in the country have that board certification. It jumps up a little bit from the average. We look at the NCS, the board certification for neurological physical therapy, about $7.55 more an hour. The OCS, about $3.89 more per hour. Unfortunately, after that, the rest of the board certifications you can expect to really not make much more per hour if anything more than your base pay. For example, women's health certification, the WCS is right at baseline pay for physical therapists, which is to say you can expect to make no more money above baseline than you do with or without the certification. Now you might be thinking, well, $2.27 more per hour on average is $2.27 more per hour than not having it, so why not go through my residency? Why not go and sit for the board certification and try to get that little pay bump? It's really important to actually go through and understand how much it costs you to get to that point and really do the math to think, is it going to be worth it for me? We need to take the account of money and time that takes into going into residency and sitting for and passing your board certification. Then we look at costs. The average residency program is about a 16-course series, usually somewhere between 12 and 24 months long. About a quarter to half of those courses are going to be in-person, which means you need to travel. It's essentially the same as going to a weekend continuing education course, so you need to buy a plane ticket and get a hotel or a rental car and all that kind of stuff that comes with travel. The rest of the courses are online or virtual lab experiences, but in general, on average across all residency programs, you can expect to pay about $15,000 for that residency and tuition, and you can expect to have some travel costs as well to attend those live weekend courses. The board exam itself is also not cheap or free. It's about a $1,000 cost for the application fee, and it's $1,500 to take the test. It's about $2,500, and that assumes that everything is correct with your application and that you pass the test on the first time. If you are missing stuff for your application or you fail the test, then obviously that cost will go beyond $2,500. In a residency, you should know that most residency programs pay you about 70% of what they would pay a full-time physical therapist, although you may also be expected to carry a full clinical caseload. What does that look like? Here at Health HQ, if we were to reduce everybody's pay to 70%, that looks like folks here would make about $30,000 less per year. Across an average of an 18-month program, that means you would make about $46,000 less than you would somebody working here full-time. So when we take all these little costs, they don't seem really that bad by themselves, but they're all part of the process to work yourself towards completing that residency and to eventually take your board certification and obtain that credential after your name. What's that total cost? It's about $60,000 to $65,000. And we look at tuition for residency, travel for weekend courses, application fees, testing fees, and lost clinical revenue because you are either doing mentorship hours or otherwise you're doing unpaid stuff in the clinic that across about a 12 to 24-month span, you're missing out on about $65,000. Some of that is lost revenue and some of that is money you have to directly pay. So now when we zoom out and think, if I make $3,500 extra per year having this board certification, how do I know it's worth it? Well, when we do the math, you need to understand that it's going to take you about 18 and a half years to break even on that investment. That an average increase of pay of $3,500 per year with a cost of a combination of lost revenue and paying into tuition and travel and fees of about $65,000, it's going to take you about 18 and a half years to break even and then finally begin to move ahead and quote unquote profit off that initial investment. So that's quite staggering, right? I'm 37 of thinking if I went to my wife and said, hey, I want to spend $65,000, I want to be gone from home even more than I already am. By the way, this investment that we're going to make of time and money will start paying it off to me when I'm 55 years old. My wife would be very upset if I went and said that to her. And I imagine a lot of you would be in the same boat of that is an extremely long time to see some sort of return on that investment. So this brings me to my last point here of the question that many folks have, whether you are watching this, listening to this, and you're thinking about entering the profession, whether you're already in school or whether you're already a member of the profession of the answer to the question of physical therapy, is it worth it, worth it? How do we know that? Where does our role play already as members of the profession? Well, we should probably do a lot better job at guiding future PTs of when we have students in the clinic who are doing observation hours, who are maybe still in undergrad or maybe even in high school of really guiding them as much as we can and letting them know, yes, it's possible to become a physical therapist, it's possible to do it in a manner that's quicker and cheaper, that there are many different routes to become a physical therapist and that if you are truly looking to get ahead in life financially and you want to have a rewarding career as a physical therapist, it's probably going to look like some combination of doing most of your prereqs at a community college, getting as many hours done in a community college as you can, get it done cheap, get it done fast, maybe even be able to work a little bit and only transfer to a four-year school if you need to take classes at that four-year program or your PT program requires a bachelor's. There are a lot of PT schools that do not require a bachelor's. They simply require 80 to 100 credits of prereq work and in some cases you can get most or all of that done at a community college. That's going to get you to PT school a lot faster and cheaper than a four-year program, especially if you don't need that bachelor's degree. And then looking at PT schools, we need to do a better job at directing these future students towards programs that maybe offer a hybrid or a flipped classroom model where they can do the majority of their didactic work online and meet up in person less often to be able to do in-person hands-on stuff that needs to be done in a lab setting. Again, the goal there is to get through PT school faster and cheaper than a traditional model so that when we look at the traditional route through PT school of a four-year or maybe even a five-year undergrad program to get your prereqs and a three-year grad school experience of a lot of folks coming out a hundred to two hundred thousand dollars in debt seven or eight years of school. That looks like a lot when we know that there are faster, cheaper routes that maybe we can get community college done in three years and maybe we can get PT school done in two years. So we enter the workforce sooner and hopefully we did it cheaper so we have less student loan debt as we start to work. That is the way we need to talk to current PT or sorry future PTs. Speaking to current PTs, the education really needs to be on don't fall for the trap. The data is here, it's clear, it's from the organization that's selling you the program of don't get caught on their hamster wheel. Don't get caught in a lifetime of school of a four or five-year undergrad program, a three-year PT school program, a two-year residency program, a five-year fellowship program where you might spend 10 to 15 years in school. You might have five hundred thousand dollars in student loan or credit card debt before you actually start to grind away at that debt, making money even if yes you will make more money per hour of it will probably take you the majority of your career to pay off that investment. So don't get caught on that hamster wheel. What should you do instead? Well we're biased but we think you should pursue meaningful education that yes improves your clinical reasoning but also lets you expose yourself to new clinical subspecialties that lets you attract new and different patients to your clinic to serve them well so they keep coming back so your caseload is fuller, you're having more fun in the clinic, and hopefully along the way you're making more money while not having this giant burden of debt hanging against your shoulder that you need to pay off. So where's the state of physical therapy in 2023? Pay is flat or negative. The pay for increased subspecialties, board certification, letters after your name does not seem to be there and what little bit is there might take you the majority of your career to actually start to pay off and see a return on your investment. Help guide future PTs on better ways to make their way to and through PT school and if you're a current PT just know that if you're thinking a board certification, a residency is really going to set me apart, there's not a lot of people especially in orthopedics that's not the case and just know that it's going to take a very long time to pay off that investment potentially somewhere between 15 to 20 years if you're still thinking about pursuing that advanced certification, that advanced residency. So I hope this helps. This is great information to have. We'll post links directly to what we share from APTA. We'll post those both in the show notes on the podcast as well in the comments here on Instagram. So we'd love to hear comments and discussion about this. I hope you all have a fantastic Thursday. Have fun with Gut Check Thursday. If you're going to be at a live course this weekend, I hope you have a fantastic time. Have a good weekend. Bye everybody.