The PT Compact has significant benefits for regulators, practitioners, and the public and continues to expand and grow. This article is based on a 2021 webinar presented by Kathy Arney, Ryann Lewis, and Jeff Busjahn.
There are several reasons why FSBPT and its member jurisdictions wanted to increase licensure mobility. There is an evolving political climate that emphasizes deregulation; therefore, enabling licensees to move from state to state helps address some policymakers' criticisms of regulation while still protecting the public. Mobility also helps expand patients' access to health care, which is especially beneficial in rural areas close to borders. However, mobility also helps expand a jurisdiction's overall workforce and gives patients more access to specialists. Additionally, licensure mobility would necessitate and encourage better data sharing, which supports public protection.
With the PT Compact, jurisdictions are not reliant on emergency authorizations to quickly increase the amount of licensed health care workers to support emergency situations. Additionally, these practitioners will be able to come in quickly while also being prepared to practice under that jurisdiction's rules and regulations.
Technology is rapidly making telehealth more feasible, even for hands-on professions such as physical therapy. Telehealth can meet patient needs, especially during the pandemic. It is also not uncommon for patients to be far from specific specialists. Telehealth, especially across states, gives patients access to that much-needed care.
While many FSBPT members were interested in creating a compact, executing such a program required concrete dedication; ten states needed to join the PT Compact before it could be established. Fortunately, by the time the initial meeting convened, twelve states had joined. The PT Compact Commission now has more than thirty jurisdictions and continues to grow.
As the Compact Commission has grown, it has gained experience and learned valuable lessons. New states do not have the same hurdles as early adopters because those early adopters have found applicable solutions.
In fact, some earlier challenges were actually disguised opportunities. For example, initially, Medicare did not necessarily recognize a compact privilege as equivalent to a license and, therefore, privilege holders were not made eligible for payment through the Medicare system. However, through a coordinated large effort by multiple organizations—including the APTA, FSBPT, and the PT Compact—the Centers for Medicare & Medicaid Services accepted compact privileges as equivalent to a license. That's a benefit for employers, patients, and practitioners.
While some jurisdictions have been concerned that they will lose licensees (and, therefore, revenue) if they join the PT Compact, existing states now have data showing that the overall licensee population numbers have remained steady. Many states choose prices that are significantly less than what it costs to get a license, which can benefit recent graduates who are often still paying off student loans. While the configuration of licensees versus privilege holders may differ, they have not seen a drop in revenue and have experienced other benefits. Additionally, most states do not find it necessary to take on new staff; they were able to fold in PT Compact processes with their current operations.
As regulators, our shared mission is to protect the public. This is one of the main reasons FSBPT supported the initiation of the PT Compact. For a compact to work, all member states must share information about their licensees—including license statuses, disciplinary statuses, encumbrances, and investigations—at least weekly. This data sharing advances public protection by ensuring a practitioner cannot circumvent disciplinary actions simply by moving to a new state.
Unfortunately, this data sharing can sometimes be a barrier for jurisdictions to join the Compact. However, as every state maintains this information already, these barriers are usually surmountable with help and guidance from the PT Compact. FSBPT also has grants to help PT Compact states address technical and administrative challenges.
Jurisdictions should consider if they want any requirements. What do licensees need to know about state rules? Do they need to take a jurisprudence exam before getting their compact or within a set time after they get their compact? Most states do have jurisprudence requirements because licensees must understand the jurisdiction's specific laws and policies before practicing to avoid inadvertent encumbrances or disciplinary action on the license.
For the PT Compact to continue to grow, boards need to promote the PT Compact not only to licensees but also to PT and PTA classes before graduation. As a Bureau Manager for the Utah Board, Jeff Busjahn enjoys going before the PT and PTA classes to explain Utah's laws, rules, and licensing procedures. These meetings can be done in-person or virtually. During these talks, he always ensures he also covers the PT Compact. He explains that the PT Compact gives PTs and PTAs access to a greater selection of job opportunities and allows for a possible reduction in license application costs. Students appreciate learning about their options, and it usually spurs a healthy discussion on different career avenues. The Utah board also shares resources on its website and newsletters. Other jurisdictions should invest in similar educations efforts for both students and licensees to support the PT Compact and its many benefits.
As a PT student, Ryann Lewis took a class called "Foundations of Physical Therapy" that covered many logistical aspects of the profession, from laws and regulations to jurisprudence exams. Fortunately, the class also covered the PT Compact. At that point, there were only about twelve states in the Compact, but Ryann still knew it was something she needed to keep in mind.
Ryann had some complicated considerations upon graduation. Her home state was Washington State, but she graduated from Pacific University in Oregon. Her fiancé's home state was also Washington, but his involvement with the Air Force meant that they would move every three to six years. Additionally, she graduated at the height of the COVID pandemic. With all this potential movement and uncertainty, Ryann knew she needed to look carefully at her licensing options. She contacted several people to learn more about the PT Compact.
She graduated in May 2020, passed the NPTE in June 2020, and married her husband in September 2020. During that time, she needed to finish school, take the licensure exam, get her home state license for Washington, and then get the compact privilege for Virginia, where they would be stationed as a couple.
She had a lot on her plate and a lot to juggle to figure out how it might work. Fortunately, she reached out to the PT Compact Administrator, T.J. Cantwell, who answered her questions and walked her through specific issues, such as defining her home state. A home state is a state of residence; usually, it is what's on your driver's license. If you are in the military, your home state is your home of record with the military. For Ryann, even though she was going to school in Oregon, her home state was Washington, as she was still a Washington resident.
After getting clarification on those issues, Ryann found it extremely easy to actually get her Virginia compact privilege. The process was seamless. The Compact website has a page detailing every state's requirements to obtain the compact privilege, including the fees and different jurisprudence requirements. She paid the fee, reviewed a practice act, and shared proof of her Washington license. Ryann has found that the PT Compact has also had unforeseen benefits, like allowing her to work along state borders.
Ryann also has former classmates who have compact privileges, which has given them much-needed flexibility and independence upon graduation. When deciding their next move, they needed to factor in financial costs, paying off loans, and the cost of living of various locations. The PT Compact allowed them to explore more opportunities.
The PT Compact Commission is currently operating on a loan from FSBPT. However, the commission needs to become financially independent and pay back that loan. Of course, part of that effort involves expanding the number of member states. As more states join, there is even more benefit, especially to border states. Having all border states be part of the Compact enhances all the PT Compact's benefits. For example, North Carolina licensee holders are most likely to get compact privileges in Tennessee and Virginia.
However, to accomplish this goal of financial independence, the Compact needs to sell more privileges. The Compact Commission decided that other revenue options, such as charging member states or increasing the cost of a privilege, were not advisable right now.
Therefore, the Compact is undertaking a marketing effort directed at licensees, graduates, and students—focusing on individuals who have two or more licenses in two or more PT Compact states. The Compact is also educating students who may leverage a PT Compact as they explore early career opportunities.
The Compact Commission hopes all FSBPT members will help in this effort by educating their licensees; talking to schools; and sharing information in their newsletters, presentations, and social media posts. By increasing the stability of the PT Compact, we are advancing our shared goal of public protection.
Kathy O. Arney, PT, MA, is a licensed physical therapist and current Executive Director of the North Carolina Board of Physical Therapy Examiners (NCBPTE). Kathy is the current Chair of the PT Compact Commission and has been a delegate and officer since its inception in 2017. She has worked at NCBPTE for thirteen years holding a variety of positions with broad regulatory experiences, and she presents frequently at PT/PTA academic programs on regulatory topics including state PT law, rules and exploring topics of common licensee practice violations. Kathy has also served on FSBPT Committees and task forces enhancing her knowledge and understanding of other jurisdictions' experiences and regulatory advantages and challenges.
Jeff Busjahn serves as the Bureau Manager at the Utah Division of Occupational and Professional Licensing for almost five years. In addition to the Physical Therapy licensing board, Jeff leads his department to provide licensing services for six other Boards, two committees and two licensing compacts. Jeff is also a Licensing Nursing Home Administrator in Texas and Utah. Prior to his employment at DOPL, Jeff was employed as an Administrator in Skilled Nursing Facilities for over twenty years.
Ryann Lewis is a Compact Privilege holder since graduating from Pacific University in Oregon in 2020. Her home state is Washington and she is currently living and practicing in Out-Patient Orthopedics in Virginia through the compact privilege. She is a military spouse and immediately knew that the compact privilege legislation would be a benefit to her as she and her husband move across the united states for the next ten years.
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