Stakeholder Perspectives on Payment for Clinical Experience: NCCE Taskforce Summary Findings and Final Recommendations
In physical therapist education, required clinical experiences are traditionally provided on a voluntary basis by licensed physical therapists (PTs). Current health care and higher education economic challenges have forced examination of policies for student PT clinical education. In 2016, The American Council of Academic Physical Therapy (ACAPT) Board charged the National Consortium of Clinical Educators (NCCE) to examine payment for clinical experiences and make recommendations. This presentation explores the NCCE Task Force (TF) findings of a national survey of stakeholder perspectives on payment for clinical experience in PT education. TF final recommendations to ACAPT will be discussed.
The TF, comprised of six clinical and eight academic PTs, conducted a literature review of health professions payment models. Ishikawa diagrams identified clinical and academic factors related to payment for clinical experience. An expert panel of 14 clinical and academic PTs performed two review rounds of survey items. The final survey was comprised of 156 Likert 5-point scale items, including four summary statements, and a final open-ended question. Two PT student advisory groups provided survey development input. A separate 12-item student survey was created. Surveys were disseminated through ACAPT and NCCE distribution lists. A snowball sampling technique was employed. Three clinical respondent roles were identified: 1) Clinical Administrator (CA), 2) Site Clinical Education Coordinator (SCCE), and 3) Clinical Instructor (CI). Two academic respondent roles were identified: 1) Academic Administrator, and 2) Director of Clinical Education. For each of the four summary statements, response differences were examined using ANOVA and Tukey Post Hoc tests for clinical roles and Independent t-tests for academic roles. Using an iterative process, TF and Expert Panel members developed five recommendations.
1,883 surveys were completed by 1,589 clinical and 294 academic/combination respondents. 2,815 student surveys were completed. Respondents were asked to Òrank your level of agreement withÓ four summary statements: 1) Clinical sites should receive payment, 2) Clinical instructors should receive direct payment, 3) Academic programs should pay, and 4) Students should pay. Mean ratings for Statements 1, 2, and 3 ranged from 1.9 (disagree) to 3.41 (neutral); and for Statement 4 ranged from 1.76 (disagree) to 2.35 (disagree). CAs exhibited greater agreement with Statements 1, 3, and 4 while CIs exhibited greater agreement with Statement 2. 94% of students agreed that sites should not charge for clinical experiences and 77% agreed that serving as a CI was a professional duty.
Conclusions/Relevance to the conference theme:
Survey findings suggest that across all stakeholders there was concern for reducing student financial burden and little support for payment for clinical experience. TF recommendations addressed: 1) legal/ethical implications, 2) reimbursement, supervision, and productivity, 3) alternative benefits and incentives, 4) national standards for payment, and 5) student tuition transparency.