Quality physical therapy care across federal medical facilities
- To provide a means by which Association members, employed by the Federal government and who work in the United States military, Department of Veterans Affairs, Public Health Service, and other federal agencies can communicate, provided education, and develop a shared vision for physical therapy across all federal healthcare systems.
- To promote quality health care across the continuum of care for those served by therapists that practice physical therapy in the Federal government.
- Provide a communication system for physical therapists in the Federal government through professional meetings and periodic publications.
- Make recommendations regarding policies that affect the physical therapy profession in the Federal government.
- Stimulate a greater participation in the Association by physical therapists in the Federal government.
- Provide opportunities for interchange of information and thereby improve treatment of patients in the Federal government facilities.
- Provide continuing education programs to help improve the quality of health care in the Federal government.
- Provide a mechanism for more active involvement in research for physical therapists in the Federal government.
- Define a system of regions to facilitate transfer of information, communication and feedback between stations.
- Establish a mechanism for communication of section needs and goals to the United States military, Department of Veterans Affairs, and the Public Health Service Affairs Central Office and the Office of Personnel Management
- Unify interpretation of federal regulations at the station level, maintaining high quality of care standards throughout the medical facilities of the Federal Government.
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The big picture: The Department of Veterans Affairs confirmed that health care professionals may provide services in a state other than the health care professional's state of licensure. The official confirmation from the VA, long advocated by APTA, is likely to help reduce anxieties among health care professionals in the VA system who practice in states (or work with patients) outside the state in which they initially achieved a license to practice. Through the interim final rule, VA establishes a new regulation that confirms the ability of VA health care professionals to practice their health profession in other states, so long as they practice within their scope of practice and VA employment requirements. Providers in the system had raised concerns about state regulatory boards' ability to allege unlicensed practice against them. The VA rule lays those fears to rest.
The aim of the rule, according to VA, is to ensure consistency in care throughout the system, whether provided in-person or via telehealth. This need for consistency is of particular importance during the VA's response to the coronavirus pandemic, which has required the health care system to mobilize health care providers to meet beneficiaries' needs — often across state lines.
Health care professionals in the VA system authorized under 38 U.S.C. 87306, 7401, 7405, 7406, 7408, or title five of the U.S. Code are covered by the rule. That coverage includes PTs and PTAs; it doesn't apply to contractors working in VA medical facilities or in the community.
National Standards Vs. State Requirements
The rule also confirms VA's authority to establish national standards of practice for health care professions by way of policy. Although the rule itself doesn't establish national practice standards, it does give the VA the authority to set them within its system and establishes protections for VA health care professions personnel against state action as long as they follow the VA standards. The VA standards themselves will be developed through a subregulatory process.
Within the rule, VA notes that adherence to its practice standards must be maintained regardless of any state licensing laws or regulations that might conflict or "unduly burden practice." When no conflict exists, VA expects its health care professionals to follow state requirements — for example to comply with a state's continuing professional education rules, as long as they don't get in the way of their employment with VA.
Awards, useful links, collaboration opportunities.
If you have linkages you feel would benefit Section Members, or corrections to these links, please send them into our office.
Clinical Education - Questionnaire Suggests Changes Needed
A recent questionnaire by a Veterans Administration (VA) committee of external stakeholders found that 85 percent of respondents believe the current model of clinical education is unsustainable and changes should be made.
Executive Order: Establishing a Commission on Care for America's Returning Wounded Warriors
POLYTRAUMA REHABILITATION CENTERS
Recent combat has resulted in new patterns of polytraumatic injuries and disability requiring specialized intensive rehabilitation processes and coordination of care throughout the course of recovery and rehabilitation. While serving in Operations Iraqi and Enduring Freedom, military service members are sustaining multiple severe injuries as a result of explosions and blasts. Improvised explosive devices, blasts, landmines and fragments account for 65 percent of combat injuries. Congress recognized this newly emerging pattern of military injuries with the passage of Public Law 108-422, Section 302, and Public Law108-447.
FEDERAL EVIDENCE-BASED RESEARCH
Please choose your branch of military service for additional information.
Physical therapy began in the military with the treatment of war wounded service men during World War I. Due to the demand for rehabilitative services, the Army Medical Department recognized the need for a formalized physical therapy education during the early 1920s and began training at Walter Reed General Hospital. The students were civilians and worked as civilians in military hospitals after graduation. In 1942, physical therapists were granted relative military rank and graduates could apply for commissions upon completion of the program. World War II increased the need for therapists and new programs were started at Fort Sam Houston, TX; Hot Springs, AK; Brigham City, UT; and White Sulphur Springs, WV.14
Following WWII, the need for therapists declined and the training of new therapists stopped. In 1947 physical therapists on active duty were assigned to the newly established Women's Medical Specialist Corps (WMSC). The Army's training program was reestablished in 1948 and trainees were commissioned as second lieutenants. The program moved to its current location at Fort Sam Houston, TX. In 1955, men were allowed into the Corps and the name was changed to the Army Medical Specialist Corps (AMSC). The program partnered with Baylor University in 1971 to become a master's degree training program. As a result of the shortage of orthopedic surgeons after the Vietnam War and their demonstrated performance, Army physical therapists took on a new role as physician extenders. As a physician extender, physical therapists are credentialed to evaluate and treat patients with neuromusculoskeletal conditions without physician referral. Since then, Army physical therapists have been providing expert musculoskeletal care and rehabilitative services to all beneficiaries in multiple care settings.15
Today, graduates of the Army-Baylor Program receive their doctor of physical therapy degree. The Army-Baylor program primarily educates physical therapists for the Army but has a small number of seats for Air Force, Navy, and /or Public Health Service. Students in this program are on active duty with their respective branch of military service while in the program and are obligated to 51 months for Army students and 60 months for Air Force students following graduation as a payback for their education and training.
In addition to the US Army / Baylor University Entry Level Doctoral Program in Physical Therapy, the Army sponsors some post-graduate level education in select fields on a competitive basis. Graduates of post-graduate level training are obligated to serve additional time following graduation as a payback for their advanced education. Although there are currently no special incentive programs for officers assessed directly from the civilian sector, once on active duty they can compete for advanced training opportunities.
Air Force physical therapists use state-of-the-art technology to practice comprehensive orthopedic and sports medicine in military hospitals and clinics throughout the world. They treat patients and engage in ergonomic evaluations and preventive medicine activities involving Airmen serving in every Air Force career from those working on the ground to those in the air. The majority of Air Force recruits are from the civilian economy as only two seats in the Army Baylor Physical Therapy Program are reserved for the Air Force. There are no dedicated ROTC physical therapist slots, but ROTC is another accession option. As in all military services, active duty physical therapists may be competitively selected to pursue advanced degrees with tuition and fees paid while incurring an active duty service obligation based on the program length. Opportunities exist for civilians to work in government service and contract positions and the Air Force is currently recruiting to fill those vacancies. At the present time there are no loan forgiveness opportunities for Air Force physical therapists.18
The Air Force is the youngest Service and shares its history with the Army from which the Army Air Corps and eventually the Air Force grew. The Air Force Medical Service was created in 1949. In the Air Force, most physical therapists work in MTFs and care for patients with orthopedic problems. More generally, physical therapists evaluate, treat and prevent orthopedic (e.g., sprains, strains, fractures), neurologic (e.g., multiple sclerosis, spinal cord injuries, cerebral palsy), and cardiopulmonary disorders (e.g., heart disease).
Finally, here's what the personnel command says a physical therapist does, "Plans, develops, and manages physical therapy programs and activities. Implements research activities. Provides and conducts training in physical therapy. Evaluates patients and treats disabilities requiring physical therapy."
Navy physical therapists are members of the U.S. Navy Medical Service Corps. The Navy Medical Service Corps has its roots in the Army-Navy Medical Service Corps Act of 1947 signed into law by President Harry Truman on 4 August 1947.16 Although Navy physical therapists were not the first members of this unique Corps, they followed soon after.
Physical therapists have the opportunity to practice comprehensive orthopedics for Sailors and Marines in Naval hospitals and clinics in the U.S. and overseas, on aircraft carriers and in pediatric in-school settings overseas.17
The Navy recruits most of its physical therapists from the civilian sector to serve in the Navy since there is only one seat in the Army Baylor Physical Therapy Program for a Navy therapist. There are currently no loan forgiveness opportunities for physical therapists in the Navy.
Origins of the US Public Health Service
The Commissioned Corps of the US Public Health Service (PHS) is one of seven uniformed services along with the Army, Navy, Marine Corps, Air Force, Coast Guard, and Commissioned Corps of the National Oceanic and Atmospheric Administration (NOAA). The Army, Navy, Marine Corps, and Air Force are within the Department of Defense (DoD), and the Coast Guard, within the Department of Homeland Security. These five services compose the armed services of the military. The remaining two services also are uniformed, but not armed services, and are located in other federal departments. NOAA is within the Department of Commerce, and the PHS within the Department of Health and Human Services.
Although the US Public Health Service may be less familiar than our sister armed services, it can trace its origins back to 1798. It was in this year that Congress passed an act for the relief of sick and disabled seamen that formed the basis of the Marine Hospital Service. In 1889, the Commissioned Corps was formally established within the Marine Hospital Service. By 1912 this service became formally known as the U.S. Public Health Service when its mission expanded to include investigation and surveillance of disease. This important work in public health sustained the service when its original mission ended with the closing of the Marine Hospitals and Clinics in 1981.1 The current mission of the Public Health Service is protecting, promoting and advancing the health and safety of the nation.
Originally an all physician corps, the PHS Act of 1944 added several disciplines including nurses and physical therapists to the corps.1 Currently there are approximately 6,000 Commissioned Corps officers on active duty organized into 11 professional categories of health and public health-related disciplines2. The Therapist Category is composed of 96 physical therapists and 43 others including occupational therapy, audiology, speech language pathology, and soon respiratory therapy.3 As one of the seven uniformed services, PHS physical therapists' pay and benefits are similar to those provided by the DoD services.
Opportunities in the Public Health Service
Commissioned officers of the PHS can be assigned to any of 12 Â operating divisions within the Department of Health and Human Services and elsewhere in the federal government (see box). Nearly all the uniformed health care providers serving in the U.S. Coast Guard are PHS commissioned officers. The relationship between the two services dates back to the 1798 Act that created the Marine Hospital Service.1
Indian Health Service. Nearly 60 percent of the physical therapists within the PHS serve in positions within the Indian Health Service (IHS).3 In the treaties of 1784, the Federal Government acknowledged certain responsibilities toward indigenous people, which included health care.4 In 1955, this responsibility for providing health care to American Indians and Alaska Natives was transferred from other programs to the newly created Indian Health Service within the PHS.1 Today, the IHS provides health services to approximately 1.9 million Native Americans who belong to more than 562 federally recognized tribes in 35 states. IHS services are administered through a system of 12 Area offices and 163 IHS and tribally managed service units with a $3.35 billion budget. The IHS also annually generates approximately $780 million in additional revenue from third party collections for the health care they deliver.5 Most physical therapists assigned to the IHS serve on the Navajo
Reservation, and in the Alaska, Oklahoma, and Phoenix areas. They are vital members of multi-disciplinary healthcare teams providing comprehensive care in both ambulatory and in-patient settings.
Physical therapy services include specialty care in diabetes, geriatrics, wound care, pediatrics, hand and foot care, health promotion and wellness programs, NCV/EMG electrophysiological examination, orthopedic, neurological, cardiopulmonary, and amputation rehabilitation, pain clinics, and clinical education. New programs have been established in women's health and phase two cardiac rehabilitation. Rehabilitation departments in Indian Health also provide facility employees with wellness and fitness programs, back care education and ergonomic evaluations. Due to the unique settings in the IHS, practice opportunities also include non-traditional community outreach, preventative education and cultural appreciation.6 In addition to the pay and benefits available to all PHS officers, some additional programs may be available for officers serving in the IHS. Participation in the IHS Student Loan Repayment Program may be possible depending on eligibility and funding availability. Officers serving in more rural locations also receive special recognition for their service.
Bureau of Prisons. The next most common area in which PHS PTs practice (25 percent) is the Federal Bureau of Prisons (BOP).3 Located within the Department of Justice, the BOP was created by law in 1930, and it included a provision to assign PHS officers to the Bureau to provide medical care to inmates.1 Inmates assigned to the BOP must be convicted of violating federal, not state or local laws. About half the offenses are drug violations, followed by a variety of other convictions. The total population in the BOP is just over 200,000. The typical inmate is male with an average age of 38 serving a sentence of 5-10 years.7 While serving their sentences, the BOP provides to inmates "essential medical, dental, and mental health services by professional staff in a manner consistent with acceptable community standards for a correctional environment".7 Annual health care costs in the BOP in 2004 were approximately $624 million.
When inmates have health conditions that are expected to require substantial or ongoing care, they may be transferred to one of six specially designated medical centers within the BOP. These medical centers include the resources typical of many community hospitals including inpatient services which are adapted to the correctional environment, and all include physical therapists on their staff. The BOP also has physical therapists working at facilities one care level below the medical center. The inmates at these facilities often require physical therapy for chronic medical needs. BOP therapists evaluate and treat either male or female inmates with a wide range of musculoskeletal, neuromuscular, integumentary, and cardiopulmonary diseases and conditions. Physical therapy services include specialty programs such as NCV/EMG electrophysiologic evaluation, Back School, and clinics with focus on the shoulder, pain, orthopedics, or orthotics and prosthetics. PTs provide wound care, evaluation and management of insensate limbs, functionalassessments, and cardiac rehabilitation. BOP therapists also host students through clinical education programs.
To support recruitment efforts, the BOP sponsors students through the Senior COSTEP scholarship program8 and has supported PHS students who completed their physical therapy degrees in the Army- Baylor education program. The therapists in the BOP receive special recognition for their service in a correctional environment. Clinical Research. Another operating division to which a few PTs are assigned is the Clinical Center of the National Institutes of Health, the nation's premier research hospital for conducting clinical research to improve health. Physical therapists have contributed to clinical research in many specialty areas, including oncology, arthritis, cardiopulmonary, and movement disorders. In the past, physical therapists have supported clinical research efforts at the National Hansen's Disease Program in Louisiana. Discoveries made there not only have minimized the disability associated with leprosy, but electromyographic evaluation methods have expanded to many diagnoses, and practice models have been translated to the care of the insensitive diabetic foot well beyond the Program. Physical therapists also have served at the National Institute of Occupational Safety and Health, a part of the Centers for Disease Control and Prevention, contributing expertise in the assessment of musculoskeletal injuries and ergonomics to improve the health of workers at their job sites.
Applied Public Health. Throughout the PHS, physical therapists support or have performed clinical, research, regulatory, and administrative functions at various operating divisions to protect, promote, and advance the health and safety of the nation.
These included assignment locations such as the Office of Disease Prevention and Health Promotion, the Centers for Medicare and Medicaid, the Agency for Healthcare Research and Quality, the Food and Drug Administration, other offices under the Secretary of the Department, and even sites you may not expect such as the US Department of Agriculture and the Environmental Protection Agency.
Other opportunities. During times of war, the Commissioned Corps has been militarized by the U.S. President. The first time was during World War I in 1917. PHS Officers were detailed to the Army and Navy primarily to help control the spread of disease during large troop movements, because disease had caused more war fatalities than wounds up through World War I.1 Even though the PHS has not been militarized since the Korean War, PHS officers have continued to provide support for DoD health related activities, primarily in the States, so DoD officers can deploy overseas. Recently the PHS has participated in DoD humanitarian training missions in Latin America and the Pacific. In addition to supporting DoD missions, the PHS offers short term deployment opportunities of several weeks to a month for its own public health related missions. Physical Therapist Officers were honored to deploy with their PHS colleagues to missions such as Fort Dix, NJ to assist Kosovo refugees, the World Trade Center site, and many southeast hurricanes, including Katrina in 2005.3
As a Commissioned Corps, there are many opportunities for PHS physical therapists to serve our patients and our nation. Over the course of a 20 to 30 year career, a physical therapist's first assignment will typically be in an IHS or BOP clinic. Subsequent assignments may include increasing responsibilities in the clinic or take other directions into applied public health and program management. In a uniformed service, each assignment offers new challenges and opportunities while building seniority within a single personnel system that invests credit toward retirement. Short tours in the inactive reserve corps also may be available for physical
therapists interested in making a smaller commitment to serve.
Operating Divisions with PHS Commissioned Officers
(and those including Physical Therapists*)
Administration for Children and Families
Administration on Aging
Agency for Healthcare Research and Quality*
Agency for Toxic Substances and Disease Registry
Centers for Disease Control and Prevention
Including National Institute for Occupational
Safety and Health*
Centers for Medicare & Medicaid Services*
Food and Drug Administration*
Health Resources and Services Administration*
Including National Hansen's Disease Program*
Indian Health Service*
National Institutes of Health*
Office of the Secretary*
Including Office of the Surgeon General*, Office
of Disease Prevention and Health Promotion*,
Office of the Assistant Secretary for
Preparedness and Response*, and others
Substance Abuse and Mental Health Services Administration
With details to DC Commission on Mental
Health Services/St. Elizabeth's Hospital*
Federal Bureau of Prisons*
Central Intelligence Agency
Department of Homeland Security
Including US Coast Guard*
Department of Defense*
Including Tricare Management Activity, US Army
Medical Research and Materiel Command
Environmental Protection Agency*
Department of the Interior
Including the National Park Service
US Department of Agriculture*
US Marshals Service
1. Mullan, Fitzhugh. Plagues and Politics: The Story of the United States Public
Health Service. New York: Basic Books, 1989.
2. Commissioned Corps Information System website http://dcp.psc.gov/
Accessed June 5, 2008
3. Therapist Category Website http://www.cc.nih.gov/rm/pt/tpac.htm
Accessed June 5, 2008
4. The First 50 Years of the Indian Health Service, Caring & Curing, DHHS, IHS,
5. IHS website http://info.ihs.gov/Profile08.asp Accessed June 6, 2008
6. IHS Physical Rehabilitation website
Accessed June 6, 2008
7. Federal Bureau of Prisons website http://www.bop.gov/news/quick.jsp
Accessed June 6, 2008
8. Student Opportunities http://www.usphs.gov/student/
Accessed June 5, 2008
â‚¬Â¢ PHS Commissioned Corps website www.usphs.gov/
â‚¬Â¢ Student Opportunities www.usphs.gov/student/
â‚¬Â¢ Therapist Opportunities
(new category website will be accessible from this location soon)
â‚¬Â¢ BOP Opportunities www.bop.gov/jobs/hsd/index.jsp
Contributed by CAPT Karen Lohmann Siegel with special thanks to CAPT Lois
Goode and CDR Scott Gaustad (IHS) and CDR Jean Bradley (BOP) for contributions on their agencies.
- Recommended Scope of Practice for Federally Employed Physical Therapists
- VA PT Residency Programs 2020
- VA Clinical Practice Guidelines http://www.healthquality.va.gov/
- VA Journal of Rehabilitation Research and Development - http://www.rehab.research.va.gov/jrrd/index.html
- Healthcare Providers and Telehealth proposed rule
- Health Care Access Standards Request for Information
- Health Care Quality Standard Request for Information
- Prosthetics and Rehabilitative Items and Services Supplemental Notice of Proposed Rulemaking
The Department of Veterans Affairs (VA) is responsible for providing federal benefits, including health care, to Veterans and their eligible family members. Today's Veterans have a comprehensive medical benefits package. The system is based on priority groups to ensure that health care benefits are readily available to all enrolled Veterans. The Mission is to Honor America's Veterans by providing exceptional health care that improves their health and well-being. Their core values are expressed via Integrity, Commitment, Advocacy, Respect, and Excellence.
The VA health care system includes 152 medical centers; more than 800 Outpatient, community, and outreach clinics; 135 community living centers; and 48 domiciliaries. VA health care facilities provide a broad spectrum of medical, surgical, and rehabilitative care. Out of the current total of 22.7 million Veterans, there are over 8.3 million Veterans enrolled to receive care through the VA. This makes up the annual 75.6 million outpatient visits and 679 million inpatient admissions that were seen in 2010. The VA also manages one of the largest medical education and health professions training program in the United States. Each year, over 90,000 health professionals are trained in VA facilities.1
There are more than 1500 Physical Therapists and 370 Physical Therapy Assistants on staff, which makes the VA one of the largest employers of physical therapists nationwide. Physical Therapists have a long history of providing care to active duty military soldiers and to Veterans. The profession's roots started with rehabilitating soldiers returning from World War I. Physical Therapists in the VA render evidence-base care that emphasizes patient-centered care, and many are recognized leaders in clinical research and education.
Physical therapists practice across the continuum of care. Opportunities exist within an acute hospital, inpatient rehab, home health, outpatient visits, and tele-rehabilitation. Enhancements in evidence-base approaches, battlefield medicine, and types of gear have helped improve the outcomes of soldiers during battles. Many recent Veterans from Iraq and Afghanistan are facing unique injuries that require complex rehabilitation.2 These injuries are related to Musculoskeletal, Polytrauma, Traumatic Brain Injury, Wound care, and Amputations. In response to the complex rehabilitation needs, the VA has set up comprehensive programs including: Polytrauma System of Care, Amputation System of Care, Assistive Technology, Blind Rehabilitation System, Spinal Cord System of Care, and advancing Tele-rehabilitation. These, in addition to the new Patient Aligned Care Teams (PACT), allow health care providers to practice at the top of their license while providing patient-centered, evidence-base care to our nations' heroes.
The demand for Physical Therapists is expected to increase within the VA, as it is for the private sector. The demand for services along with the aging workforce will create opportunities for those wanting to establish their career within the VA. The VA is always taking steps to improve recruitment and retention. Education is a priority for the VA. This has been shown by stipends for students and more recently, establishing residency programs at select sites. The opportunities are endless. To learn more about current job opportunities, please view www.vacareers.com or contact the VHA Physical Therapy Program Lead, Dr. Mark Havran DPT, at Mark.firstname.lastname@example.org, 515-699-5999 x9-5510. To learn more about the VA please go to: www.va.gov.
The link below is an interactive website for researching VA careers in Physical Therapy. Please see the information at the link below and share with interested colleagues, personnel preparatory programs and students.