Well I really should begin by saying that I never intended to write a forth part to this series - but the journey continues.
I passed the NPTE which I sat in October 2016 and in November I received notice from the Physical Therapy board of California (PTBC) that I was required to complete 9 months of supervised practice according to Californian Code of Regulations section 1398.26.5.
In order to begin that internship, the place where I was hoping to be employed had to meet certain requirements as a clinical supervision facility.
Pre-approval to become a PTLA
The following requirements need to be pre-approved before you gain the title a physical therapy license-applicant:
- Notice of intent to supervise a foreign physical therapist
- Clinical site information form
- APTA certified Clinical instructor
So here is the catch. Each applicant is assessed on a case-by-case basis and it takes at least 30-60 days to find out if you can begin work. I knew about being supervised but I didn't know that the site had to be PTCB-approved and I didn't know that my clinical instructor had to have taken a specific on-site training course. This last part held me up for 3 months - finding a certified CI.
So if you are trying to speed up the process of starting work I would suggest finding out where you want to work and seeing if there are any APTA CIs that work there. If not, then you might suggest to your future employer to register for a course in advance. The courses fill up very quickly (my CI missed 2 of them) and the processing time for the certificate can be between 2-8 weeks. So 8 weeks to get the CI certificate and then 30 days for the board to finalise the application. Thats easily 3 months of waiting for approval that can begin while you're still waiting for your results of the NTPE. Had I known this would take so long, I would have begun in October.
Appealing the board's decision
Another reason that my start date was delayed is that my employer appealed to the board to waive the supervision requirements. On January 17th (10 weeks after sending the appeal) I received the decline. I have heard of people have some success with this in the past and I'm still glad that we tried to skip the internship but it seems that California is very strict on these requirements for foreign-trained applicants.
Ethics and Professional Law
According to California Code of Regulations section 1398.26.5. "3 months of this internship can be waived" if you complete a recognised 40 hour course in Ethics and Professional Law. I completed this course (self-paced) through Federico Grosso. Federico was prompt in replying to all my emails, sent me the material the day after I registered ($360) and sent my certificates the same day that I completed the examination. I would recommend taking the same course as I couldn't find any others that met the '40 hour' requirement. These certificates were sent to my case manager at the PTBC and I received a letter saying that I was approved to waive 3 months from the internship, only if my CI deems that at the 6 month mark, that I demonstrate the skills necessary to work independently as a 'entry-level' Physical Therapist.
On February 16th I received notice from the PTBC that my PTLA status was approved and that I could begin my 6 month internship. Here are some things I have learnt along the way that aren't directly spelt out but very very important to know.
- You must have an APTA credentialed clinical instructor to act as your supervisor.
- This CI must be onsite for direct and immediate supervision for 6 months.
- The internship (9 months without ethics, 6 months with) is as a full time position. If you don't work 40 hours a week you need to complete it for longer.
- If you don't complete your internship within 12 months of being approved to begin, you application for licensure closes and you need to begin again.
- You must be with your CI at all times.
- If they go on vacation or have a sick day then you can not practice.
- If you spend time shadowing a non-credentialed CI, then it doesn't count towards your hours.
- Based off this information I now have two CIs so that if one is not available I can continue working under the supervision of the other.
- You may not treat Medicare B patients.
- Your CI may not treat Medicare B patients if you are concurrently treating another patient. Just no Medicare for either of you really.
- Be sure that your employer understands these restrictions because they only exist for foreign PTLAs, not Californian PTLAs.
At 3 months your CI will complete a midterm evaluation using the APTA clinical performance instrument (CPI). This instrument is usually used via an online tool for Californian students and each student is linked to their CI via a portal. For foreign PTLAs you don't get a temporary license number and instead are linked to your CI, so the portal doesn't exist and your CI completes a paper copy. If they aren't able to download a paper copy of the CPI, your case manager at the PTBC can email your CI one (on request).
For the CPI there needs to be a new comment on both the mid term and final assessment for all 18 categories. The CPI rates if the PT is at an entry level standard and is completely subjective. It is based on the CI’s interpretation of the PTLA’s skills and not based on school curriculum requirements. When writing the midterm evaluation, you can write down notes leading up to that evaluation.
I actually chose to completed the CI course March 4/5th to further understand the role as a clinical supervisor and instructor according to APTA standards. It was very interesting and I hope this opens me to further teaching opportunities when I am fully licensed, or maybe enables me to help other foreign PTLAs.
I am currently 2 months through my internship and have 4 more months left of full time work and supervision before I can submit the final application for this. I believe the board has 30 days to make their decision and review my paperwork before issuing a full license. It has been exciting to work again, nerve racking to enter into a system that is so different to Australia, and despite the time I have been a practicing therapist, there is so so much to learn. It is very difficult to learn about the American billing system and insurance without on-site practice and I am extremely grateful for the support and guidance of my CI's in showing me the ropes.
I am very thankful and grateful to Sydney James and the team at TherapydiaSF for taking me on board and collectively supporting me through this final stage. It is wonderful to be working as a Physical Therapist again and makes the past 2 years feel so worthwhile. When it is all over, it will be just over 3 years in total since I began. What an adventure! Fingers crossed nothing else comes up. If it does, I'll be sure to let you know. For now, I get to go to work again each day to learn, grow and help my patients which is what I love most about our profession and what we do.