Joint Hearing of the Committee on Homeland Security and Governmental Affairs of the U.S. Senate and the Committee on Veterans’ Affairs of the U.S. House of Representatives at 1:00 p.m. CDT.
Witness Testimony of Jeffrey L. Newman, PT, and Chief, Physical Therapy Department, Member, American Physical Therapy Association, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN
Chairman Michaud, and members of the Subcommittee on Health, thank you for the opportunity to testify on the recruitment and retention of qualified health care professionals to work in the Department of Veterans Affairs’ (VA) Veterans Health Administration (VHA). These professionals, such as physical therapists, are vital to meet the rehabilitation needs of our nation’s veterans today and tomorrow.
I am proud to say I have practiced as a physical therapist in the VA system for more than 30 years, and for 20 of those years I have served as Chief of the Physical Therapy Department at the VA Medical Center in Minneapolis, Minnesota. As you may know, this facility is also one of the four designated Polytrauma Rehabilitation Centers (PRC) providing care to patients with a wide spectrum of rehabilitation needs including those with Traumatic Brain Injury (TBI). I come before you today as a member of the American Physical Therapy Association (APTA) which represents over 70,000 physical therapists, physical therapist assistants and students of physical therapy nationwide. I have served in several leadership posts within the Association including past President of the APTA’s Veterans Affairs’ Section.
In my experience providing physical therapist services and managing a team to provide rehabilitation services, I have seen the physical therapy profession advance to meet the changing rehabilitation needs of our patients. The primary challenge to continue to meet the rehabilitation needs of veterans is the recruitment and retention of physical therapists. This challenge is compounded by two trends that increase the need for physical therapist services: chronic conditions associated with an aging veteran population and the complex impairments associated with returning veterans from Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF) in Iraq.
In my remarks today, I will discuss the increased need for physical therapists in the VA system, highlighting current challenges with recruitment and retention of physical therapists within a changing environment that only increases the need for rehabilitation lead by these professionals. I will make two specific recommendations to help meet these challenges and ensure our nation’s veterans the accessibility and availability to the physical therapists services they need to regain mobility and function to ensure they achieve the highest degree of independence and quality of life in their homes and communities. These recommendations are the immediate approval and implementation of pending qualification standards and focused enhancements to current VA scholarship programs for physical therapists.
Physical Therapists in the VA: An Increasing Need For Rehabilitation Services
Physical therapists (PTs) are health care professionals who diagnose and manage individuals of all ages, from newborns to elders, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. Physical therapists examine and develop an individualized plan of care using treatment interventions to promote the ability to move, reduce pain, restore function, and prevent disability. Physical therapists also work with individuals to prevent the loss of mobility by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.
With more than 1000 physical therapists on staff, the VA is one of the largest employers of physical therapists nationwide. Physical therapists have a long history of providing care to our active duty military and to our nation’s veterans. In fact, our professional roots started by rehabilitating soldiers as they began returning from World War I. Back then, physical therapists were known as “reconstruction aides.” Today, physical therapists in the VA render evidence-based, culturally sensitive care and many have been recognized leaders in clinical research and education. Physical therapists in the VA practice across the continuum of care, from primary care and wellness programs to disease prevention and post-trauma rehabilitation. Clinical care practice settings that include physical therapists include inpatient acute care, primary care, comprehensive inpatient and outpatient rehabilitation programs, spinal cord injury centers and geriatric/extended care.
The need for high quality rehabilitation provided by physical therapists has never been greater with the dual challenges of caring for the chronic diseases faced by aging veterans and the multifaceted profile of many of today’s wounded warriors. According to the VA, 9.2 million veterans are age 65 or older, representing 38% of the total veteran population. By 2033, the proportion of older veterans will increase to 45% of the total. Among this aging veteran population, a high prevalence of diabetes is a critical chronic disease challenge for health care providers. Physical therapists are specialists in facilitating or regaining mobility and function lost due to diabetes and its complications as well as its prevention strategies.
The second trend that highlights the need to recruit and retain physical therapists in the VA is the changing profile of injuries and impairments of our returning service personnel. Enhancements in battlefield medicine have helped a larger portion of soldiers survive their injuries, compared to previous wars our nation has fought. Many of our nation’s recent veterans are facing unique injuries that require complex rehabilitation including spinal cord injury, amputee rehabilitation and traumatic brain injury. Physical therapists are a key part of the VA’s Polytrauma Rehabilitation Centers (PRC) caring for TBI patients in Tampa, Palo Alto, Richmond and at my facility in Minneapolis. PRCs have clinical expertise and include an interdisciplinary team to provide care for complex patterns of injuries, including TBI, traumatic or partial limb amputation, nerve damage, burns, wounds, fractures, vision and hearing loss, pain, mental health and readjustment problems. Physical therapists are also part of the specialized amputee rehabilitation center at the Brooke Army Medical Center at Fort Sam Houston, Texas.
Physical therapists at the Minneapolis VA facility – and at other facilities - have been at the forefront in developing programs to care for our wounded warriors prior to the creation of the PRC designation. Minneapolis has had a TBI program with dedicated staff in TBI rehabilitation for over 10 years. We have physical therapists on staff who have received American Board of Physical Therapy Specialties (ABPTS) specialist certification in neurological, clinic specialists in geriatric, and orthopedic physical therapy. My specific clinical background is in amputation rehabilitation. I have had the honor of caring for a generation of veterans and have been able to see the growing need for physical therapist services through the years.
Current Recruitment and Retention Challenges for Physical Therapists in the VA
Given the increasing number of aging veterans and the number of OEF/OIF veterans needing physical therapist services, recruitment and retention of qualified physical therapists is vital to ensuring our veterans have access to the physical therapist services they need in a timely fashion. The number one obstacle to both the recruitment and retention physical therapists to serve in the VA is the severely outdated qualification standards that currently govern the salary and advancement opportunities for physical therapists employed by the VA. These standards have not been updated for nearly 25 years.
The physical therapy profession has evolved as the need for our services has expanded. Unfortunately the VA has not kept pace with current professional practice standards and is quickly falling behind clinical areas outside of the VA and other health care professionals with similar or lesser qualifications within the VA. The current minimal requirement to become a physical therapist is to graduate with a master’s degree (approximately 80% of programs now are graduating at the doctoral level) and pass a licensure test. The current VA qualification standards still only require a physical therapist to obtain a bachelor’s degree and do not recognize the doctorate of physical therapy or DPT degree. Not only is this severely out of date with current minimal education requirements but it is not competitive with clinical settings outside of the VA system.
I recommend the immediate approval of revised qualification standards for physical therapists to establish a consistency between the VA and the current professional practice of physical therapy and to achieve equity with health care professionals of similar education, experience and expertise currently practicing in the VA. The APTA in representing physical therapists practicing in the VA, strongly supports the immediate approval of these qualification standards.
APTA began working with the VA to update the qualification standards over six years ago and supports the following changes to establish consistency between the VA and the current professional practice of physical therapy as defined by the Guide to Physical Therapist Practice:
- Recognition of Educational and Clinical Training of the Physical Therapist,
- Clarification of a career ladder in the Department of Veterans Affairs for Physical Therapists,
- Recognition of the Doctoral Degree in Physical Therapy, and
- Expanded opportunities for career advancement for physical therapists.
Unfortunately while the APTA has received feedback from the VA that changes need to be made to update the qualification standards, these recommendations have not been implemented. Establishing appropriate and up to date qualification standards will make it easier to both recruit and retain physical therapists to serve our nation’s veterans.
The need for immediate approval of these revised standards is due to several factors. First, the demand for physical therapist services on the rise, the outdated qualification standards have made it difficult to recruit physical therapists to the VA system. Second, the increased need for services provided by qualified physical therapists in the VA due to the two trends outlined above – providing services for our aging veterans and meeting the complex rehabilitation needs of our returning soldiers. Third, the outdated qualification standards also limit the ability of a physical therapist to advance within the VA system once they have joined. The current standards do not recognize physical therapists that achieve specialty certification such as those needed in the polytrauma centers. Fourth, it has been at least 6 ½ years since the VA first recognized that the standards needed to be updated. These pending regulations should be implemented immediately.
In addition to the immediate approval and implementation across the board – not just in select facilities - of the revised qualification standards, I recommend enhancements to the current VA scholarship programs for physical therapists to help in both recruitment and retention. Many new graduates are concerned with a high amount of student loan debt when leaving school, scholarship and loan repayment programs are an important tool in to recruiting additional physical therapists to meet the VA’s need.
I had the opportunity to serve on the committee to review scholarship program applicants in the early 1990s when the VA had – in my opinion - a very successful scholarship incentive program to attract new graduates. Over the course of that particular program, my facility in Minneapolis had five recipients. One of those original recipients is still in my facility, two of the other stayed for several years with only two leaving directly after their required service was complete. The previous scholarship program provided an incentive to serve right out of school whereas the new incentive program including the debt reduction program is poorly advertised and cumbersome for the potential applicants. In 2007, only 19 physical therapists have participated in the Education Debt Reduction Program and only 14 physical therapists have participated in the Employee Incentive Scholarship Program.
In closing, APTA recommends the immediate approval and implementation of the qualification standards for physical therapists in the VA and the investigation of options to enhance current programs offering scholarships, loan support and debt retirement for physical therapists choosing to serve in the VA. This will assist in both the recruitment and retention of qualified physical therapists to meet the needs of our veterans today and tomorrow.
Physical therapists are a vital part of the health care network that provides services to our nation’s veterans. Ensuring that the qualification standards that govern the salary and advancement opportunities for physical therapists in the VA are up to date and reflective of the current professional practice of physical therapy as well as enhancing current scholarship opportunities will help recruit and retain more physical therapists to the VA system.
Thank you for this opportunity Mr. Chairman, I would be happy to answer any questions you or the other committee members may have.
 At the end of fiscal year 2006, 1024 physical therapists were employed by the VA. Department of Veterans Affairs.
 “Research in VA Geriatrics Centers of Excellence” Fact Sheet May 2006. Department of Veterans’ Affairs website. Accessed October 15, 2007.
 Atul Gawande, “Casualties of War-Military Care for the Wounded from Iraq and Afghanistan,” The New England Journal of Medicine, vol.351, issue 24 (December 2004) p. 2471.
“2005-2006 Fact Sheet, Physical Therapy Education Programs.” Pg 4. American Physical Therapy Association. January 2007.
 According to information on physical therapists from the HRRO Education Database provided to APTA by the Department of Veterans’ Affairs on October 15, 2007.