Specialization in Clinical Electrophysiology Stands Out From All Other PT Specialties With Up to 50% Increase in Salary

Is enrolling in a physical therapy residency program the right choice for me?

This blog post is intended for students in entry-level physical therapy programs who are nearing graduation and practicing physical therapists who are looking for a change in their clinical career path or want to further their post-graduate education. 

Completing an entry-level degree in physical therapy is a time-consuming and expensive endeavor. According to the 2021-2022 Aggregate PT Program and Salary Data¹ published by the Commission on Accreditation in Physical Therapy Education (CAPTE), the mean percentage of enrollees from total applicants to physical therapy programs is 12% and the mean undergraduate or pre-professional phase GPA of those enrollees is 3.56. So, it takes dedication and hard work just to become accepted into an entry-level program. Once starting the program, the mean total number of credits required to complete it is 120 including over 35 weeks of full-time clinical education experiences. The graduation, ultimate licensure exam pass rate, and employment rates are very high; 96.7%, 98.4%, and 99% respectively. Unfortunately, the financial costs of this education are also high. The total cost of the professional phase excluding room and board averages $69,826 for in-state tuition at public colleges & universities to $120,656 for private ones. 

Upon graduation, many new physical therapists seek employment opportunities where they can receive mentorship as they master their skills or work in areas of specialty practice such as cardiovascular and pulmonary, clinical electrophysiology, geriatrics, neurology, oncology, orthopedics, pediatrics, sports, women’s/pelvic health, and wound management. Recent graduates also desire to emulate the career paths of influential academic and clinical instructors and obtain board certification in one of the professions’ 10 specialty areas.  The quickest way for a therapist to qualify for a board certification exam is to complete a credentialed residency program. However, after the rigorous effort to complete physical therapy school, new graduates may be reluctant to commit to the formal structure of enrolling in a post-professional residency program. According to the 2021 Aggregate Program Data² published by the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE), most programs (95%) utilize a full-time format and have a mean completion time of 12.7 months. The success rate of residency programs is comparable to entry-level programs, with a mean graduation rate reported at 92% and a first-time board certification exam pass rate of 94%.

Several benefits of completing a physical therapy residency program and obtaining board certification have been discussed³. Physical therapy residency graduates obtain more clinical experience and didactic instruction in specialty areas that are not covered in detail in entry-level education. A second benefit of a physical therapy residency program is working directly with mentors who have already obtained board certification status in that specialty area. Residents have reported that direct mentoring improves their productivity, improves career satisfaction, facilitates networking opportunities, and reduces anxiety and stress.  The ABPTRFE requires that all credentialed programs have documented one-on-one mentoring sessions between resident and mentor and that mechanisms exist so that the resident receives constructive feedback on their clinical performance. 

A considerable con of enrolling in a physical therapy residency program beyond the cost of time is the financial costs of a residency program, both in tuition and in earning potential. In 2021, 32.2% of all residency programs charged a tuition, with the average tuition totaling $7,020.² While 90% of programs provided salary, the percentage of salary compared to an equivalent PT was 77%.² This resident-to-generalist ratio is much more favorable than the ratio for medical residents and primary care physicians.  The salary of an average first-year medical resident is $60,000⁴ while the average salary of a primary care physician was $260,000⁵, equaling a resident salary percentage of 23%. However, if you consider the ultimate purpose of completing a residency program to earn board certification, the earning potential value of physical therapy specialist is much lower than a physician specialist. According to a survey of physicians across 29 specialty areas⁵, the average salary of specialty providers was $366,552. This represents a 71% increase in salary for a physician with a specialty versus one without. So, the time spent by a physician in a residency program provides significant earning benefits upon attaining board certification. The US Bureau of Labor Statistics reports that in May 2022, the national mean and median annual wages for physical therapists were $97,960 and $97,720 respectively across all industry types/work settings⁶. Unfortunately, the average 23% salary reduction while in a residency does not seem to translate into a comparable increase in salary upon obtaining board certification. It has been reported that board-certified physical therapists make approximately $10,000 more in salary than non-board certified counterparts⁷.  This represents a 9% salary increase from the mean described above for a salary decrease while in the residency of 23%. In addition, in a survey of employers of geriatric, neurologic, orthopedic and sports physical therapy residency-trained employees, only 19% of employers provided residency graduates or board-certified therapists promotions, increased compensation, or financial support during the residency⁸.  

There is one specialty area of physical therapy practice where pros of enrolling in a residency program to obtain board certification is not outweighed by the con of a small increase in earning potential.  Of the 10 specialty areas, the only one where there is a significant expansion of practice and increased ability to use additional CPT codes to bill third party insurers is clinical electrophysiology. A physical therapist who has obtained board certification in clinical electrophysiology from the American Board of Physical Therapy Specialties (ABPTS) is permitted to utilize CPT codes on insurance claim forms to the Centers for Medicare and Medicaid Services (CMS) that other physical therapists cannot⁹. Unlike other specialty areas, there is a direct financial benefit to obtaining board certification. Since there is a direct financial benefit to the practice, employers value a residency graduate and board-certified specialist in clinical electrophysiology more than a non-residency graduate and non-board-certified physical therapist who performs clinical electrophysiologic (EMG & NCV) tests. A membership survey was recently conducted by the author of this blog article, who is the administrative officer of the Electrodiagnostic Special Interest Group (EDX SIG) of the Academy of Clinical Electrophysiology and Wound Management (ACEWM). Seventy-two members responded to a six-question survey. Seventy four percent of respondents reported knowledge that insurance reimbursement for clinical electrophysiologic testing is higher than other outpatient physical therapy services. In questions specific to owners of physical therapy practices who employ others to perform EMG & NCV tests and outpatient physical therapy services, 87% (13/15) indicate the rate of pay for those performing EMG & NCV tests is higher than those who perform other outpatient physical therapy services. Additionally, 76% (13/17) of practice owners reported the rate they pay a physical therapist who has achieved board certification in clinical electrophysiology to perform EMG & NCV is between 10% – 50% higher than a physical therapist who has not achieved board certification to perform the same tests. In questions intended for non-owners, 70% (31/47) of respondents reported that their rate of pay performing EMG & NCV is higher than the rate of pay they received engaging in other aspects of physical therapy practice. The non-financial benefits reported by all respondents included 71% (45/63) indicating higher job satisfaction engaging in clinical electrophysiology practice and 93% (53/57) indicating that obtaining board certification in clinical electrophysiology distinguishes them as a provider of these services more than obtaining board certification in another area and providing those services. 

Earning an entry-level physical therapy degree and completing a post-professional residency program can be time-consuming and costly ventures. This article describes the general pros and cons of physical therapy residency programs and board certification.  Additionally, it emphasizes the differences in one specialty area of physical therapy practice, clinical electrophysiology. Currently, there is only one ABPTRFE-credentialed residency program in clinical electrophysiological physical therapy that utilizes a resident employment model.  The EMG Solutions Residency Program in Clinical Electrophysiology includes over 276 hours of didactic training consisting of 11 full days of in-person lectures and discussion, 3 days of remote lectures, 8 days of laboratory practice, and 7.5 days of independent study. In addition, the program far exceeds the minimum number of direct one-on-one mentoring hours and the number of EMG & NCV patient exams that a graduate performs more than adequately prepares the graduate to sit for the specialty exam and independently see all types of patients.  If you would like more information about our program, please visit our website or contact our residency program director or director of office operations.  

John Lugo, PT DPT

Board-Certified Clinical Specialist in Clinical Electrophysiologic Physical Therapy

Program Coordinator, EMG Solutions Residency Program

Site Coordinator of Clinical Education, EMG Solutions

References:

1. 2021-2022-aggregate-pt-program-and-salary-data: https://www.capteonline.org/globalassets/capte-docs/aggregate-data/2021-2022-aggregate-pt-program-and-salary-data.pdf 
2. 2021-physical-therapist-residency-and-fellowship-education-programs-fact-sheet: https://abptrfe.apta.org/contentassets/0d387cabf64a4d30a80f2417679294e5/residency_fellowship_fact_sheet_2021.pdf 
3. The Pros and Cons of Attending a PT Residency Program as a New Grad: https://rizing-tide.com/blog/the-pros-and-cons-of-attending-a-pt-residency-program-as-a-new-grad/ 
4. 6 things medical students should know about physician compensation: https://www.ama-assn.org/medical-students/specialty-profiles/6-things-medical-students-should-know-about-physician 
5. Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain: https://www.medscape.com/slideshow/2022-compensation-overview-6015043#2 
6. Occupational Employment and Wage Statistics, May 2022; 29-1123 Physical Therapists: https://www.bls.gov/oes/current/oes291123.htm#(2) 
7. Why Physical Therapy Residencies/Board Certifications Do Not Make Financial Sense: https://youtu.be/Mtp3VbBW_08 
8. Briggs, M. S., Whitman, J., Olson-Kellogg, B., Farrell, J., Glaws, K. R., Walker, J. M., … & Tichenor, C. J. (2019). Employer Perceptions of Physical Therapists’ Residency and Fellowship Training: Insights for Career Development Planning. Journal of Physical Therapy Education, 33(1), 40-48.
9. Department of Health and Human Services Health Care Financing Administration Program Memorandum Carriers Transmittal B-01-28. April 19, 2001: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/B0128.pdf