What do we lose without diversity? What do we gain with diversity? What elements of diversity should physical therapy boards be working on? This article is based on a 2020 Annual Meeting Webinar panel discussion with Anne Wallestad, Ruggie Canizares, Nancy Kirsch, and Adrienne Price.
According to Anne Wallestad, the CEO of BoardSource, boards tend to be overwhelmingly white. While Board Source compiles information about other marginalized identities, the disproportionately low racial and ethnicity data stands out.
It is also notable that in the more than twenty years since BoardSource has been collecting data, this has continued to be a problem with minimal incremental progress. BoardSource is looking at not only what it has been in the past and what it is now, but also what actions and initiatives need to happen to create change.
FSBPT has also been examining this for quite some time. Unfortunately, across our committees and member boards, we probably are not as well represented as we should be to reflect who we are and the communities we protect. While FSBPT has always valued diversity, the events of the last few years have made FSBPT and members hypersensitive to it and eager to find out what actions we can implement to address this need.
According to CAPTE, in 2019, the majority of graduates from PTA programs were white:
When looking at the PTAs in practice from 2016-2017, it is evident that more work needs to be done to have a more inclusive profession:
While this is not where we want to be, there are some reasons for optimism. Out of about 35,000 PTA test-takers in a recent five-year span, 66% provided race and ethnicity information at registration:
If we compare this to the data of 2019 PTA graduates, with 71% identifying as White, there is a positive trend toward diversity. Unfortunately, this is not the case with PTs. According to CAPTE, in 2019, the majority of graduates from PT programs were White, and, at 77%, it is a more significant share than the 71% for PTA graduates:
Additionally, for PTs in practice from 2016-2017, there is still little diversity:
While the PTA workforce has seen growing diversity, the PT workforce compared to graduates actually shows a slight increase in White PTs. However, once again, there is reason for optimism when looking at the data for PT test takers:
However, it is essential to remember that the test taker data is incomplete. Only 59% of candidates responded to this question when registering for the NPTE, similar to the PTA response level. There may be many reasons people do not want to report their ethnicity. For example, they may have concerns about exclusion and inclusion or how that information might be used. Additionally, individuals may wonder if the given labels are appropriate for them, so they may opt to just not to share that data instead.
Recently, the Oregon Board of Physical Therapy sought to increase its diversity. Oregon has four statutes, one executive order, and one governing initiative that all compelled the board to examine its diversity. In December 2018 and November 2020, the board held diversity strategic planning meetings.
Instead of approaching each statutory requirement in isolation, the board decided that it made more sense to develop a holistic approach. They developed a Framework for Culturally Responsive Regulation to consider the components of diversity, equity, inclusion, racial justice, and cultural competency in the context of these four groups:
Any regulatory policy or rule will consider the role of and the impact to these groups with the end goal of achieving culturally responsive regulation.
As part of the framework, the board developed questions to help guide them:
The board also identified key issues:
The board has made progress:
Diversity, equity, and inclusion are essential to work towards actively. You do not know what you do not know. The opposite of exclusion is intentional inclusion, not the absence of something intended to exclude. It is crucial to be proactive about inclusion. This approach can take different strategies and involve different layers within an organization; in reverse, problems in one area can reverberate across the organization.
The education community should go beyond just being intentional with recruitment and also provide additional services to students with different needs. In a recent incoming class at Rutgers University, 51 percent of students identified themselves as part of an underrepresented minority. Ideally, recruitment needs to start before college or even high school. Efforts really need to begin in middle school. Programs and initiatives that encourage more students to consider becoming a PTA or PT are great opportunities for collaboration between APTA and FSBPT.
Of course, we cannot simply wait until today's middle school students become tomorrow's board members. Despite the many challenges to achieving diverse representation, board members need to address this issue now. These challenges may include organizational intent and leadership. Even if we have state-mandated initiatives, how the board adopts these initiatives can make a huge difference.
At the basic, fundamental level, we are talking about human interactions and relationships. People may want to include someone, but they may also be hesitant to ask about various potentially sensitive categories someone might belong to. For example, a group of White colleagues talking about Black Lives Matter may think it is not okay to talk about that around a black colleague. It can be a challenge for both parties to have the courage to ask uncomfortable questions and answer them. However, engaging in this dialogue is vital. When navigating differences, people can be insecure; therefore, navigating them effectively requires vulnerability, humility, and courage.
Board members should actively invite those who are not at the table. It is important to note that it does not matter that the board is diverse if the other board members do not respect and listen to the diverse voices, even if it is different than what they usually hear. Make a conscious effort to have these sometimes uncomfortable discussions and find out if people feel they are included. Collaborate with them to help proactively promote inclusion. Strive to understand the feedback and implement it if possible or, if not, explain why the board cannot implement it to ensure that the speakers know the board is listening to them, they are being heard. It is essential to build trust and transparency.
Boards also must look at research and data to see if sanctions are harsher for minorities. Some of the empirical data shows attendees of remedial training are disproportionally PTs and PTAs educated outside of the United States, often because they have some trouble adapting to a different health care environment. State boards should analyze this data. Some resources include the Physical Therapy Minimum Data Set (PTMDS) and the Healthcare Regulatory Research Institute (HRRI), an FSBPT-created nonprofit regulatory research organization. While jurisdictional legislation may prevent specific data collection, there should still be some available options.
Expanding a state board's diversity and ensuring marginalized voices are represented takes courage in leadership and courage for under-represented groups to ask difficult, challenging questions. However, this courage is necessary. Boards cannot protect the public if members of the public do not feel comfortable accessing PT services or reporting claims to the board. They need to know the board will accept and listen to them to feel comfortable. Therefore, diversity is critical to a board's mission of public protection.
Anne Wallestad serves as president and CEO of BoardSource, a globally-recognized nonprofit focused on strengthening nonprofit leadership at the highest level — the board of directors. Acknowledging the critical partnership between boards and executives, and the impact of that partnership on overall organizational success, BoardSource helps nonprofit leaders invest in their leadership partnership by providing research, thought leadership, and practical supports that help transform board structures, dynamics, and perspectives. Since becoming chief executive in 2013, Anne has overseen a period of growth and change, and significant expansion of BoardSource's leadership on critical sector-wide issues, most notably the board's role in advocacy and public policy, the opportunity for boards to think more proactively about strategic alliances and restructuring, and the urgent need for board action and change as it relates to diversity, inclusion, and equity.Nancy has been a member of the New Jersey Board of Physical Therapy Examiners since 1990 and was chairperson of the board for twelve years. She served as an evaluator for FCCPT. Nancy has been involved with the Federation of State Boards of Physical Therapy in the following capacities: she served two terms on the Finance committee and also served on several task forces, in addition to the Board of Directors. Nancy has been active in the American Physical Therapy Association since she was a student. She served the New Jersey Chapter as Secretary and President, and as a delegate and chief delegate to the House of Delegates. She served the national association as a member of the ethics document revision task force. She also served a five-year term on the APTA Ethics and Judicial Committee and the APTA Reference Committee. She received the Lucy Blair Service Award and was elected a Catherine Worthingham Fellow from National APTA and received an Outstanding Service Award and the President's Award from the FSBPT.
Nancy R. Kirsch, PT, DPT, PhD, FAPTA, received her PT degree from Temple University, her Master's in Health Education from Montclair University, Certificate in Health Administration from Seton Hall University, her PhD concentration in ethics from Rutgers University (formerly UMDNJ), and a Doctor of Physical Therapy from MGH Institute of Health Professions. She practiced in a variety of settings including in-patient rehabilitation, acute care, long-term care, and home care. She owned a private practice for twenty-five years and currently practices in a school-based setting. In addition, she is the Director of the Doctor of Physical Therapy Program, and Vice Chair of Rehab and Movement Sciences, at Rutgers, The State University of New Jersey.Nancy has been a member of the New Jersey Board of Physical Therapy Examiners since 1990 and was chairperson of the board for twelve years. She served as an evaluator for FCCPT. Nancy has been involved with the Federation of State Boards of Physical Therapy in the following capacities: she served two terms on the Finance committee and also served on several task forces, in addition to the Board of Directors. Nancy has been active in the American Physical Therapy Association since she was a student. She served the New Jersey Chapter as Secretary and President, and as a delegate and chief delegate to the House of Delegates. She served the national association as a member of the ethics document revision task force. She also served a five-year term on the APTA Ethics and Judicial Committee and the APTA Reference Committee. She received the Lucy Blair Service Award and was elected a Catherine Worthingham Fellow from National APTA and received an Outstanding Service Award and the President's Award from the FSBPT.
Ruggiero (Ruggie) S. Canizares, PT, MS, MBA, CMPT, received his PT degree from University of Santo Tomas, his Master's in Exercise Physiology from Southern Connecticut State University, his Master's in Business Administration from Northwest Christian University (MBA Sigma Beta Delta International Honor Society), and his Certified Manual Physical Therapist (CMPT – certified “with distinction”) from The North American Institute of Orthopedic Manual Therapy. Ruggie practiced in various clinical settings including acute care, in-patient rehabilitation, nursing home and long-term care, and in-school pediatrics. He currently owns a private practice that has been operational since 2008 and also works per diem as a Home Health Physical Therapist in a local regional hospital.In 2011, Ruggie was appointed to the Oregon Physical Therapy Licensing Board and completed his second four-year term in 2019. Ruggie served as Board Vice-chair from 2014 to 2018, and as Board Chair from 2018 to 2019. He has been actively involved with FSBPT since 2014 as a delegate/alternate delegate and served two terms on the Finance Committee. Elected in October 2018, Ruggie is currently serving his first term as FSBPT Treasurer. Ruggie continues his active role in regulation and public protection by serving as a public member on the Oregon Mortuary and Cemetery Board.
Adrienne D. Price, RN, BA, MSN, obtained her associates of science in nursing from Macon State College, her bachelor of arts degree from Mercer University, and her masters of science in nursing from the University of Phoenix. As a registered nurse, she practiced in a number of different health care settings including obstetrics, gynecology, hospice and palliative care, pediatrics with a concentration in developmental disabilities, public health, and nursing regulation as a Legal and Disciplinary Nurse Consultant. The National Council of State Boards of Nursing (NCSBN) appointed her as the Promising Practice Consultant for Discipline on the Committee for the Commitment to Ongoing Regulatory Excellence (CORE). She was also a member of the National Association of Drug Diversion Investigators (NADDI).In 2013, she was instrumental in the development, editing, and the selection of content for the board of nursing’s quarterly magazine, The Georgian Nurse. She also served on the County Health Emergency Assistance Resource Team (CHEART), an affiliate of the Public Health Task Force for the Georgia Emergency Management Agency (GEMA) in the North Central Health District. Adrienne has been with the Professional Licensing Boards Division of the Georgia Office of Secretary of State for fourteen years and has served in her present role as the Executive Director of seven licensing boards, including the Georgia State Board of Physical Therapy, for seven years. She has been involved with the Federation of State Boards of Physical Therapy as a member of the FSBPT Membership Survey Task Force, a member of the FSBPT Resolutions Committee, the Chair of the FSBPT Re-entry to Practice Task Force, and a recipient of the FSBPT Outstanding Service Award in 2018.
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