When Will the PT Compact be Active?

A lot has been happening behind the scenes to bring the PT Compact to fruition. We have a lot of good news and things to look forward to in the near future, but also some restrictive rules that travel PTs need to be aware of.

Let’s start with a couple pieces of good news about the compact:

The Compact Commission and Colorado have come to an agreement that officially ends Colorado’s suspension from the compact. Colorado had previously been suspended from the compact because of the state’s “Michael Skolnik Medical Transparency Act” that requires all healthcare workers in Colorado create an online profile. Per the rules of the compact, the requirement for a profile is an additional burden on compact licensees that is not allowed. Other states have similar requirements, but their laws exclude professionals seeking a license through a compact. APTA has worked tirelessly with contacts in the Colorado legislature and with FSBPT to come to an agreement. Legislation has been drafted that if passed would remove the additional requirements for compact PTs and PTAs. Also, the state has assured the commission that it will not seek disciplinary action on individuals participating in the compact in relation to the Medical Transparency Act. Given the efforts made by Colorado, the commission lifted the state’s suspension this past Friday.

The compact was passed into law in the first 15 states last year, and the compact is set to be live in “the first half of 2018” (per PTcompact.org). At the rate most bureaucratic processes move, it is amazing that it is scheduled to take less than one full year from the inception of the compact commission to having actual reciprocity of PT licenses across state lines. To make things even sweeter, 8 other states are currently considering the compact in their legislature, and more states are expected soon. Achieving a compact between over 20 states in less than 2 years would a great feat! I’ve said it before, and I’ll say it again – states that are not in the compact are going to have a hard time filling their staffing needs. Many travel PTs will choose to travel only within the compact states for the increased ease of license transfers. This will greatly shrink the candidate pool in the non-compact states that are still relying on an antiquated, cumbersome license verification process.

FSBPT has also launched a new website for the compact PTcompact.org, click this map to visit.

…but here’s the catch that every traveler should know about. The current compact rules restrict compact privileges to only those PTs and PTAs with a permanent address in a compact state. To be clear: your tax home has to be in a compact state to participate in the compact, you cannot merely hold a license in a compact state to enjoy the reciprocity. The PT compact came into existence largely because of traveling PTs, and now, the current rules cut out a great number of travelers. The reason for this rule is the commission does not want PTs “license shopping” – meaning, if one state has lower standards, or lower fees, they do not want to flood that state with thousands of travelers who are trying to get in on the compact. Travelers who do not hold a home address in a compact state must continue with the same-old process, even if they are traveling within compact states. I, personally, see a simple solution – grandfather all PTs or PTAs currently holding a license in a compact state – boom, tons more well-vetted travelers admitted to the system with no shopping. But in the meantime, state licensure staff will continue to review hundreds of paper verifications from PTs already holding licenses in compact states, travelers will spend weeks completing the appropriate, pointless paperwork, and the inconveniences that the compact was designed to avoid will largely continue –  I digress.

So what can we all do to improve the system and allow more travel PTs into the compact?  I wrote a letter to the compact commission prior to their adopting these rules explaining my aggravation and the need to allow more travelers into the system.  I have since been in contact at length with APTA staff, Compact Commission Staff, and others. My concerns have definitely been heard, but it would helpful for the compact commission to hear that same concern from others.

There are 2 topics to take action on:

  1. Travelers need to be working to make non-compact states become compact states. APTA members should be contacting their state chapter to let them know adoption of the compact rules is a legislative priority. Colorado wouldn’t be a compact state if I hadn’t spoken up to make it happen – but once I had mentioned the idea, it was quickly taken up as a priority and set into motion.
  2. Travelers should be letting their licensure board, APTA representatives, and FSBPT know that the current compact rules that require residency in a compact state harm the efficiency of the compact. The purpose of the compact is to eliminate barriers to licensure between states for well qualified individuals. The current rules restricting compact privileges to permanent residents of compact states fail to optimize the potential of the compact to help travelers and the member states alike.

If you aren’t sure who to contact, your local APTA chapter is a good place to start. But, as the compact is an agreement among states, contacting your state board is an excellent next move after contacting your APTA chapter. The PT compact is moving forward, but it definitely needs the help of the travel PT community to move it in the right direction!

Open Letter to the PT Compact Commission

The Physical Therapy Compact is marching forward which is good news for a lot of PTs and PTAs currently practicing in compact states. But, by my interpretation, the currently proposed rules which will be voted on next weekend leave a lot of therapists who could utilize the compact out in the cold. Basically, therapists who call any compact state their permanent home will have access to compact privileges, but therapists hoping to access the compact whose permanent address is not in a compact state, or who have no permanent address at all, will not be able to take advantage of the PT licensure compact.

Here is a ink to all current info on the compact including the proposed rules and info on compact commission meetings: http://www.fsbpt.org/FreeResources/PhysicalTherapyLicensureCompact.aspx

Enough of an intro – Below, you will find the letter I have written to the PT Compact Commission about my concerns regarding the new rules and my ongoing concerns about the suspension of Colorado from the compact.

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The most current PT Compact map from FSBPT.org. At the start of the new legislative cycle this winter, more states should be introducing the compact.

To Whom It May Concern,

I write from a point of frustration today, but hope that my comments can be productive to the process of developing a compact system that is available and useful to as many Physical Therapists and Assistants as possible.
First, just a brief background on me to help you understand my view points and my frustrations. My wife and I worked as traveling Physical Therapists for 10 years, over that time we held licenses in 7 states each (8 states total). Our permanent address changed frequently due to a variety of reasons including us each coming from different states individually, our parents living in different states, and a flow of life over 10 years that caused our permanent address to change independently of our federal “tax home” address which also changed several times. During my early years of traveling, I was based in Massachusetts, that later changed to Florida, Maine, and Colorado. For several of those early years traveling, I was the lone PT sitting on FSBPT’s Exam Administration Committee. Because of those experiences within with FSBPT, in 2012, I felt at liberty to write a few emails to FSBPT about developing some sort of national licensure registry – later that year, FSBPT leadership had its first conversations (that I am aware of) about pursuing what would eventually become the licensure compact. Earlier this year, my wife and I, now with newborn, settled permanently in Colorado where I made the case to my local APTA leaders to pursue the licensure compact and later testified before state legislators in support of adopting the compact. Over the past several years, I have offered to contribute to the compact development process through FSBPT and also through APTA where I have served in a number of leadership positions through Sections and Chapters, but I was never offered any real opportunities to take part in the compact development. To this point, I have not found the process transparent or easily accessible, so a phone call or a couple emails may be all it takes to explain commission processes and ease my concerns which are listed below.

1. My biggest and most predictable concern is regarding the suspension of Colorado. My information regarding the suspension came to me through asking questions to people who were closer to the initial compact commission meeting and reading the meeting minutes – it seems the initial decision to suspend Colorado came following an executive session and did not consist of much open, transparent conversation. In the months since, I have tried to understand the suspension and am still left not understanding why Colorado would be suspended due to requiring additional consumer protections. I have read the compact commission statement posted on FSBPT many times and fail to see a comprehensive explanation or even an explanation that makes sense. It seems the stance of the commission is that Colorado should change its laws that govern all medical and health professions rather than the commission changing its rules to be more accepting of the variances in regulation it will undoubtedly run into as more jurisdictions become members. In my reading of the draft rules, I expected to find something that would resolve the Colorado suspension, but found nothing that would seem to indicate the commission is trying to reintegrate Colorado into the compact. In the past several months, I have been asked by many traveling PTs and Colorado PTs about the suspension, I have assured them that with time the commission will and must come to its senses and find a way to reintegrate Colorado into the compact. My faith that the commission would want to modify its rules to allow as many states into the compact as possible is being challenged now as months and months pass by. It seems that additional background check requirements would fall right in line with other variances that are explicitly allowed – differences in CEU requirements, differences in state fees, juris prudence exams – why not additional consumer protections? If the commission cannot resolve this small issue, then surely the dream of a majority of states being compact members will not become reality. Again, I have tried to access meaningful information regarding Colorado’s suspension, but it is simply not available – I would truly be happy with a more comprehensive and explanatory statement from the commission on Colorado’s suspension, provided that the rationale behind it actually makes sense.

2. In my reading of the draft rules, I came to a separate, but not unrelated concern regarding the definition of “home state”. As a long-term traveling PT, I may have a perspective that has not been adequately represented to the commission. Traveling PTs often do not have a permanent address, or they have an address that changes often. The definition of “home state” (Rule 1.1, I) and Rule 3.5, B, 2 seem to exclude any PT or PTA from the compact that does not have a permanent residence in a member state or does not have a permanent residence at all. It seems to me that this is EXACTLY the licensees you would want the compact to be open to. The traveling therapist community are the therapists who would most benefit from the compact. They also are undoubtedly the ones cluttering the desks of licensure staffs across the country. In my mind, “home state” should be defined by whichever state a licensee enters the compact through. To be clear, I should be able to live in a non-compact state, hold a valid license in any compact state, and have access to compact privileges. The current language does not allow this, I beg the commission to reconsider with my added view point – traveling PTs are exactly who would use the compact and exactly who clinics in member states want to be attracting to fill their needs. Just last week, while presenting at APTA’s National Student Conclave about careers in travel PT to several hundred students, I commented that compact states would become popular destinations for travelers and that there would high competition for the jobs in those states – with the currently proposed rules, this would not be the case. The current definition of home state means that only therapists originating from compact member states would be able to access compact privileges. Many of the member states that are largely rural will continue to experience difficulties in in filling open PT job positions, and all state licensure staffs will continue to be overburdened by the volume of work they are doing for travelers who could potentially have compact privileges if the “home state” definition were different.

3. Finally, my last point is a brief one, and perhaps one that just needs some clarification or explanation to me. Rule 5.1, C excludes anyone on the board of directors of APTA or any one of its sections, chapters, or councils to not be eligible to be a delegate to the commission. I’m frankly not sure what an APTA council is – is that any committee within APTA? It seems this rule excludes a large portion of Physical Therapists and Assistants who have any interest in policy making from participating in shaping and refining the commission. This is not a handful of PT leaders, but hundreds. Again, I may just need an explanation on this, but it is concerning to me that all leaders in our profession would be excluded from commission leadership.

There is one theme and commonality between each of my concerns, and it is about inclusion of as many therapists as possible in the compact system. So far, what I am seeing is a system that waits for states and individual therapists to comply with commission rules to be included in the compact, rather than a commission that seeks to include as many states and therapists as possible. For the compact to be a truly useful entity, it needs to be available to states to join and available to as many well qualified therapists as possible. I hope the commission will genuinely consider my view points and suggestions. And, again, I am happy to help and contribute to the process, I would love to offer more perspectives of the traveling therapist’s experience in licensure.

Sincerely and Respectfully,

Dr. James Spencer, PT, DPT
Orthopaedic Clinical Specialist
www.HoboHealth.com

PT Compact Update – The first 10 are in!

The PT Compact is no longer just a dream of travelers – it’s happening! Washington State’s Governor just signed the PT compact into law making Washington the 10th state to adopt the compact. Before you go on reading this, take a look at the current status of states working on adopting the compact: https://www.fsbpt.org/FreeResources/PhysicalTherapyLicensureCompact.aspx

Ten states and counting!

The compact needed 10 states to go live. The compact commission will now be formed which will develop and maintain the specific rules and regulations for the compact. With 10 states having adopted the compact, it is now a reality – but, there’s another 8 states currently considering the compact in their legislatures. I assume licensure reciprocity between compact states will be a reality sometime during 2018 – only a guess. I also suspect that by that time, we will be somewhere in the neighborhood of 25 to 30 states participating in the compact. If the states that aren’t yet talking about the compact haven’t realized it yet, they are going to be at a big disadvantage for recruiting PTs to their states. This will be especially true in states with less PTs graduating from programs than the public demand for PT; There are very few states that are able to supply their full PT workforce independently. If your state is not pursuing the compact yet, get on it! States not involved with the compact are going to be losing PTs to compact states that allow licenses to be easily transported across state lines.

I’m psyched. I first started letters to FSBPT in March of 2010 suggesting improved reciprocity between states. Later that year, in October, FSBPT leadership charged their Board of Directors with researching the development of an interstate licensure compact – coincidence? I’d like to think not (so I can take credit for the whole thing), but I guess we’ll never know the full truth. Although, Rachel Jermann reached out to me this week with a quote from Lucy Blair’s 1971 McMillan Lecture, “Several recent studies have contained challenges that licensure and registration on a state basis are barriers to the movement of personnel from state to state and are handicapping adequate distribution.” …I guess we’re all about 45 years late to the party.

Colorado HB17-1057 PT compact testimony #coleg

Me testifying to the House Health, Insurance, and Environment Committee sitting next to Rep. Larry Liston who sponsored the PT Compact bill. Picture taken by and stolen from Cindi Rauert. P.S. Cindi is killing it in PT Advocacy (twitter: @cindirauert)

As I have pushed for the compact to be pursued here in Colorado, I have learned a lot about the legislative process. Here in Colorado, the compact legislation was introduced to the house of representatives in January. In Colorado, a bill can be introduced to either chamber of the state congress (House or Senate). Once it passes one chamber of congress, it then progresses to the next. Most states have a similar system. Depending upon the content of the bill, it is required to be reviewed by particular committees in each chamber. I got the chance to testify before the “Health, Insurance, and Environment Committee”. I have long looked forward to doing this kind of work, but lacked the passion for any one particular topic. The compact gets my juices pumping – it hits close to home with travel therapy and I feel like I’m very well versed in the topic of interstate PT licensure. Describing my experiences with licensure in travel PT to the committee of 11 state representative was both very rewarding and extremely terrifying. I was well prepared, which got me through, but I became very, very nervous while testifying despite all the very nice things said about PT by the Representatives on the committee. We can’t forget that our profession touches many peoples’ lives, including politicians. I suspect with repetition in testifying my nervousness will subside, I hope I get the chance to continue this kind of work in the future.

There were a couple other PTs testifying that opened my eyes to the PTs and patients outside of the traveling world that will benefit from the interstate compact:

  • Military families who move often without warning would benefit greatly from improved licensure portability.
  • PTs entering telehealth are running into licensure issues because: Are they practicing physical therapy where the PT is located? Or where the patient is located? The answer to this question is unclear at this time.
  • Newly graduating PT students who are at school out of their home state and are unsure of where they will practice – stay and practice where they are in school or return to their home state? These students would be helped by being able to more freely take their license between states.
  • And, of course, let’s not forget all of the employers and, most importantly, the patients who would benefit from having easier access to PTs, especially in rural communities where PT recruitment can be difficult and on state borders where an available PT may live just a few miles away but be limited by the lack of state reciprocity. (see other letters of endorsement from other businesses, consumer advocates, and policy organizations)

So what are the arguments against the PT compact?

Apparently there aren’t many, since the compact is bulldozing its way across the country. It just makes good sense that in this time of internet and air travel that PTs and PTAs should be allowed to transport their licenses across state lines more easily – I think state legislators see that practicality. It is easy for them to see that increased license portability is good for therapist, patient, and business alike.

But, there are a few legislators that do vote against the compact. Let’s entertain for just a minute that there might be significant opposition to the compact (which there is not). I can think of two reasons passing the licensure compact might be opposed:

  1. The 10th Amendment to the Constitution protects states’ rights to govern licensure within their borders. There could be a perceived loss of individual state control through the compact. Although, the way the compact is set-up allows a state to repeal the compact legislation at anytime to return to their individual governance of PT licensure. Also, this is the way driver’s licenses work – a driver’s license interstate compact is what allows you to drive across state borders. Compacts are nothing new.
  2. Cost. There can be some costs with implementing the compact. It requires fairly strict licensing standards – background check, finger printing, etc which can cause cost to the state or increase the cost of being licensed. Some states are simply absorbing this cost through increased licensure fees. The way I see it, the compact would remove a host of administrative burdens which, in turn, would increase efficiency and recoup cost from the current antiquated, cumbersome process.

I’m so excited about the compact. It’s a system I have pictured for many years and believe it will tear down one of the great barriers travel PTs and PTAs face. I foresee the states that are involved in the compact will become prime-targets for travelers while the non-compact states may struggle to find the temporary and permanent help they need. So, get your state in. I don’t care if it’s your home state, the state you are working in, or the state you are at school in. Start talking about it to people in your state that can create legislation and make it happen.

I’m excited to have been a part of the process here in Colorado but would like to do more. For now, I’ll do everything I can to keep moving the PT compact forward and make sure it passes here – we’re getting close. Working on this topic that I care about and know deeply is a great first step to being more involved in PT legislation. State legislatures are ultimately the gate-keeper for a patient’s ability to access our full scope of practice in each state. We need to continue to demonstrate to them the commonsense quality and cost-effectiveness of the services that Physical Therapists provide across the country.