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PHYS THER
Vol. 87, No. 3, March 2007, pp. 261-281
DOI: 10.2522/ptj.20060003
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Research Reports

Administration and Management Skills Needed by Physical Therapist Graduates in 2010: A National Survey

D Sue Schafer, Rosalie B Lopopolo and Kathleen A Luedtke-Hoffmann

DS Schafer, PT, PhD, is Professor and Associate Director, School of Physical Therapy, Texas Woman's University, Dallas, TX 75235 (USA)
RB Lopopolo, PT, PhD, MBA, is Professor, Department of Physical Therapy, Arcadia University, Glenside, Pa
KA Luedtke-Hoffmann, PT, PhD, MBA, is Assistant Professor, School of Physical Therapy, Texas Woman's University, Dallas, Tex

Address all correspondence to Dr Schafer at: sschafer{at}twu.edu


Submitted January 4, 2006; Accepted October 10, 2006


   Abstract
 
Background and Purpose: Administration and management (A&M) skills are essential to physical therapist practice. This study identified which A&M skills will be most critical for future Doctor of Physical Therapy (DPT) graduates to possess upon entry into clinical practice.

Subjects and Methods: Using a 7-point scale, 435 randomly selected American Physical Therapy Association members (physical therapists) rated 121 A&M skills based on expectation of the level of independence required by a new DPT graduate.

Results: No differences among respondents based on role, work setting, or experience were found, so the data were combined for factor analyses, producing 16 A&M skill groups. The most independence was expected in skills related to self-management, compliance with rules, ethical behavior, and insurance coding. Skills requiring the most assistance were marketing and strategic planning, financial analysis and budgeting, and environmental assessment.

Discussion and Conclusion: This study has identified the level of independence for the A&M skills needed by new DPT graduates, provided empirical evidence suggesting which A&M skills should be included in DPT curricula, and suggested a pattern of A&M skill acquisition that applies first to the new therapist and the patient, then to the organization, and finally to the health care environment.


   Introduction
Top
 Abstract
 Introduction
Method
 Results
 Discussion
 Conclusion
 Appendix.
 References
 
In today's health care environment, it is difficult for any clinician to manage the care of patients or clients without considering their resources, the reimbursement that may be received for the services provided, and a myriad of factors related to the organization and operation of his or her clinical practice. Therefore, we believe that leadership, administration, management, and professionalism (LAMP) skills are integral to the clinical practice of physical therapy.

The original LAMP1 conceptualization, with its 4 elements symbolizing independent business or practice management functions, did not emphasize the integration of clinical practice with practice management. However, as we examined the nature of LAMP skills1 and studied the relationship of LAMP to the American Physical Therapy Association's (APTA's) Vision 2020,2 it became clear that the concepts of leadership, administration, management, and professionalism were not only interdependent with one another, but also were interrelated with the elements of the patient/client model from the Guide to Physical Therapist Practice (Guide)3 and included many of the generic abilities described by May et al.4 Thus, we felt that a revised conceptualization of the LAMP acronym was needed to depict these relationships and further research in this area.

In the revised conceptualization (Fig. 1),5 professionalism provides the contextual background for all physical therapist practice, while the administration and management (A&M) skills that depict the business side of physical therapist practice, together with the Guide's3 patent/client management skills, provide the content necessary for optimal physical therapist practice. Finally, leadership is the means through which the content of practice is professionally applied to the problems facing the physical therapist. Leadership can take many forms and represents the roles that therapists assume to fulfill their professional responsibilities in their chosen practice arenas.5


Figure 1
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  		Figure 1. Conceptualization of Leadership, Administration, Management, and Professionalism (LAMP) model integrated with patient/client management model.

 
If, as we propose, LAMP skills are important to clinical practice, then we need a clearer understanding of which of these skills are appropriate to include in professional physical therapist education programs and which are better left for development at a later stage in the therapist's career. The APTA's Normative Model, which guides physical therapist curriculum content, lists 5 categories of A&M content expected of new graduates: direction and supervision of human resources, participation in financial management, establishment of a business plan, participation in marketing and public relations, and use of other business strategies in physical therapist management.6(pp70–71) However, the Normative Model does not articulate which specific skills or groups of skills are most critical for newly graduated physical therapists to have upon entry into clinical practice, nor does it indicate the level of skill or knowledge that should be required. Furthermore, it is not known whether these 5 suggested content areas are the most appropriate areas that need to be addressed by physical therapist educators.

In 2004, Lopopolo et al7 laid the groundwork for identifying the administration and management content that should be included in professional physical therapist curricula. Their research produced an extensive list of A&M behaviors that was organized according to a Guide-based framework of business management suggested by the Leadership, Administration, and Management Preparation (LAMP) document.1 Although Lopopolo and colleagues' list of behaviors appeared to be exhaustive, the authors suggested that using this organizing framework "may have ... affected the clarity and relationship of the components [behaviors] within the elements [categories] and may have influenced the respondents' ratings."7(p147) Because of these shortcomings, a new framework for organizing A&M skills was needed to advance this line of research.

In other disciplines, the framework for administrative and management content been historically been organized by functions performed3,8–11 or roles assumed by managers.12–14 Recently, Luedtke-Hoffmann15 created a 6-category model of A&M content derived from an extensive review of business and health care management literature and tested it using an expert group of physical therapist managers. The categories in this model were: planning and forecasting, managing subordinates, managing operations, building networks, managing information, and managing resources.

The results from her research suggest that management tasks in physical therapy are similar to and fall into the same general categories as found for all managers, regardless of industry. The findings also suggest that this 6-category model is an appropriate organizing framework for the administrative and management work of physical therapists. Preliminary sorting of Lopopolo and colleagues' list of A&M behaviors7 using Luedtke-Hoffmann's findings15 suggests the following 6-category A&M model: finance, information management, networking, human resource management, operations, and planning and forecasting (FINHOP).5

Using the FINHOP model, we sought to determine which administration and management skills will be needed by newly graduated physical therapists in the year 2010. The year 2010 was selected to capture changes in the A&M skill set needed in clinical practice as the profession moves toward APTA's Vision 2020,2 when all entry-level (professional) physical therapists are projected to be prepared at the doctoral level. This date also was selected to provide the survey participants with a more realistic time frame (5 years out) when thinking about the needs of therapists in future clinical practice as compared with 2020 (15 years out). Because we were interested in the views of a cross-section of physical therapists and because previous research suggested that opinions of physical therapists regarding A&M content might differ based on work setting16 or primary role (clinician versus manager),17 we first needed to be sure that the responses from our sample of participants were representative regardless of work setting or role. Therefore, we tested the following hypotheses:

  1. There is no difference between clinicians and managers on the average scores of any of the 6 FINHOP categories.
  2. There is no difference among the 4 practice settings on the average scores of any of the 6 FINHOP categories.
  3. There is no interaction between roles and practice settings on the average scores of any of the 6 FINHOP categories.

If no differences were found, we could combine all responses to address the primary research question: Which administration and management skills will be needed by newly graduated physical therapists in the year 2010?


   Method
Top
 Abstract
 Introduction
 Method
Results
 Discussion
 Conclusion
 Appendix.
 References
 
Sample

To obtain a diverse representation of opinions on the research questions, physical therapists from across the United States who worked in various clinical practice settings were surveyed. A sample of 2,500 physical therapists was drawn from the APTA membership list in October 2004 and stratified into those in clinical practice and those in academia to ensure a sufficiently large response from full-time educators. Specifically, 2,000 names were randomly selected from members in clinical work settings, and the remaining 500 (20% of the total sample) were randomly selected from members whose primary setting was academia. The overall sample size of 2,500 was established because we anticipated a response rate of approximately 20%, which is typical for a complex, mailed survey. In addition, a power analysis suggested that between 400 and 500 participants would be needed for the planned statistical analyses, based on an effect size of approximately 0.20, an alpha level of .05, and a desired power of 0.70.18

A total of 435 physical therapists returned the survey questionnaire for a response rate of 17.4%. Four hundred seventeen of the survey questionnaires were considered usable and were included in subsequent analyses. Participants included full-time educators (21.2%), full-time clinicians (32.6%), clinicians with some managerial responsibilities (41%), and others who had retired or were temporarily out of the workforce (5.2%). Respondents lived in 46 states, the District of Columbia, and Puerto Rico and were well distributed among 10 regions defined by APTA (Tab. 1). Seventy percent of the participants were women. Just over half of the respondents (57.3%) had completed a baccalaureate physical therapist professional education program, and half (50.4%) reported that the master's degree was their highest earned degree (Tab. 2). Nearly half of the participants (47.7%) had up to 16 years of experience as a physical therapist (Tab. 3). The predominant clinical practice setting was private, outpatient, or group practice (23.4%). All of these demographic outcomes were consistent with the APTA's 2005 member survey results, which reported on data gathered in 2004.19


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  		Table 1. Distribution of Participant Sample by Location of Practice (N=417)

 

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  		Table 2. Educational Background of Study Participants

 

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  		Table 3. Years of Experience as a Physical Therapist as Compared With American Physical Therapy Association Data (n=405)

 
Survey Instrument

As stated previously, a new survey instrument was needed: (1) to organize the A&M skills in a manner that is consistent with the business and management literature, (2) to produce a more parsimonious survey instrument than had been used in Lopopolo and colleagues'7 original research (ie, complete in its capture of all appropriate content, yet practical and efficient for survey respondents to complete20), and (3) to transform all behaviors into skill statements by changing definitions into action statements.

As a starting point, we used the FINHOP model as a framework to organize the A&M skills defined by Lopopolo and colleagues' research7 (see Tab. 4 for category definitions). The steps involved in the placement of the A&M skills within the 6 category framework included: (1) an initial refinement of the skill list and skill definitions by the researchers, (2) a card sort process using subject matter experts (SMEs) to place the skills into the appropriate FINHOP category, (3) a follow-up review and categorization of skills that had not been consistently categorized in the card sort step, and (4) an examination of the skill list for exclusivity. These steps are outlined more completely in Figure 2. Card sorting has long been used in the social sciences as a means of gathering survey data to understand how people think about the organize a set of concepts.21–24 This method has been found to be a fast and interesting way to obtain valid and reliable data that can be analyzed using ordinal statistical procedures and appears to be effective in reducing the more serious forms of systematic response error.22


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  		Table 4. FINHOPa Categories and Definitions

 

Figure 2
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  		Figure 2. Steps in administration and management (A&M) instrument refinement. The acronym "FINHOP" represents the 6 categories of the administration and management model (see Tab. 4 for FINHOP categories and definitions).

 
During the follow-up review of 19 skills that had not been consistently categorized by the SMEs, 2 of the 3 researchers independently reviewed the skills, identified problems that likely hindered their classification during the card sort process, and suggested options for resolution. Invariably, the problem with skill classification related to imprecise skill definitions. Due to time constraints, the researchers did not go back to the SMEs for placement of these skills into categories. Rather, the researchers agreed on category placement of 17 skills and deletion of 2 skills that were considered to be redundant. The last step was to establish preliminary subcategories within each FINHOP category to examine the skills for exclusivity. Fourteen additional skills were deleted at this step, resulting in 121 skills for inclusion in the final A&M survey instrument.

The final survey instrument (questionnaire) was compiled into a 12-page booklet format. The first and second pages included demographic questions and instructions, and the last page allowed for participant comments. The remaining 9 pages included the list of 121 skills along with their corresponding definitions, grouped within the FINHOP categories. The list of skills with their accompanying definitions is included in the Appendix. For each skill, participants were asked to identify what they believed would be the skill level, and the accompanying knowledge level, needed by a newly graduated physical therapist to be successful in clinical practice in the year 2010. Each item was scored on a 7-point Likert-type level of independence scale that measured both skill and knowledge levels, where a score of 7 represented total independence and a score of 1 represented total dependence (Fig. 3). Survey participants were instructed to first select the skill level and then determine the appropriate level of accompanying knowledge. The resulting combination would determine the actual score to be circled for each skill. Because the format for the response scale was more complex than is typically found in a survey instrument, the wording used in the scale and clarity of instructions were pretested using a group of 10 clinicians. The refinement of wording and clarity proceeded until group consensus on these characteristics was achieved.


Figure 3
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  		Figure 3. Survey scoring system.

 
Unlike in the Delphi study by Lopopolo et al,7 in which skill and knowledge were viewed as separate constructs and were measured on 2 separate scales, in the present study we considered skill level (ie, level of independence) to be the primary construct that is supported by requisite knowledge. Therefore, our 7-point measurement scale was designed to capture both constructs simultaneously (Fig. 3).

We interpreted a median score of 7 to mean that the new graduate would be ready for independent performance of an A&M skill, whereas at the other end of the spectrum, median scores of 1 and 2 would indicate no expectation for readiness to perform the skill. Median scores of 3 and 4 would indicate a need for substantial assistance to perform a skill, and median scores of 5 and 6 would indicate that the new graduate should be moderately independent (ie, ready to perform the skill with only limited assistance). Differentiation of scores between 3 and 4 or between 5 and 6 were based on differing levels of knowledge that would be required. For example, while only limited knowledge related to a skill would be required for a score of 5, the new graduate would be expected to have substantial knowledge related to a skill to have a score of 6. If one considers being able to perform a skill with only limited assistance as the baseline expectation for entry-level performance, then we interpreted that A&M skills with a median score of 5, 6, or 7 should be considered for inclusion in Doctor of Physical Therapy (DPT) education programs and receive more emphasis than A&M skills with scores of 1 through 4.

A final step was to test the stability of responses for the entire survey. We selected 16 physical therapists from a variety of work settings to participate in a test-retest reliability study. Each participant completed the entire survey twice with a minimum of 2 weeks between sessions. Using a paired t test to compare the first- and second-survey scores on the overall average of all 121 items, no differences were found between the first and second sets of scores (t=–.503, df=15, P=.623). This result suggests overall stability of responses over time, but does not address the potential variability of responses within the 6 FINHOP categories. To explore this issue, intraclass correlation coefficients (ICCs) were calculated for the responses within each FINHOP category using the average of all items within each category as the variable of interest.

The ICC was selected because it is a measurement of both correlation and agreement between repeated measures, while taking into account the variance in responses, and therefore is an appropriate statistical means to examine test-retest reliability.20,25,26 Because average scores were used in the calculation, ICC model 3,k was selected, where k is the number of raters.27 Furthermore, a 2-way mixed-effects ICC model was selected, where raters' effects are assumed to be random and survey item (average) scores are fixed.25,27 The calculated ICC (3,k) values for each FINHOP category were as follows, in descending order: human resources=.90, operations=.80, finance=.78, planning and forecasting=.77, networking=.61, and information management=.61. Portney and Watkins28 suggested that ICC values ≥.75 suggest good reliability, whereas values <.75 represent poor to moderate reliability. Our results suggest good test-retest reliability in 4 of the 6 FINHOP categories and moderate reliability in the remaining 2 categories.

Procedure

The questionnaires were mailed to the random sample of 2,500 physical therapists in November 2004. Participants were informed that the return of the completed survey questionnaire would be construed as informed consent. Each package included the survey booklet, a cover letter explaining the project and requesting participation, a stamped return envelope, and a small incentive (APTA decal). Reminder postcards were sent to the entire sample 2 weeks after the initial mailing.

Data Analysis

To address the 3 preliminary hypotheses, we used the following independent variables: role of respondent (clinician, manager, educator) and work setting (inpatient, hospital-based outpatient, community outpatient, other community-based practice). The dependent variables were the average scores of the skills within each of the 6 FINHOP categories.

Two analyses were necessary to identify whether differences existed in participants' responses due to demographic variables. First, a chi-square test of independence was used to determine the association between the 2 clinical roles (clinician versus manager) and the 4 practice settings. Then, a 2x4 factorial multivariate analysis of variance (MANOVA) was conducted to test the 3 null hypotheses stated above. If no differences were found in these analyses, then 1-way MANOVAs were performed to determine whether the average scores of any of the FINHOP categories differed based on role (educator, clinician, and manager) and the participants' years of clinical experience as categorized in Table 3.

If no differences were found in any of the analyses, the responses from all participants could be combined to address the primary research question. First, to study the correlation of responses within each FINHOP category and to determine whether the responses clustered together into subcategories (skill groups), an exploratory principal component factor analysis with varimax rotation would be performed on each FINHOP category.20,21 Scree plots and eigenvalues ≥1.0 would be used to ascertain the appropriate number of skill groups within each category. Then, each exploratory analysis would be followed by a confirmatory factor analysis to verify placement of skills into skill groups based on similar levels of independence. A factor loading of 0.5 or greater would be used to determine the appropriate placement of each skill in a skill group. Subsequently, the skill groups would be named by the researchers based on the nature of the skills included in each skill group.20 The names would reflect the level of independence of the skills in the skill groups. In addition, an analysis of the internal consistency reliability (Cronbach alpha) of each FINHOP category and subsequent (statistically derived) skill group would be performed to assess the consistency of responses.

Finally, the descriptive statistics for the FINHOP categories, skill groups, and individual skills could be examined to answer the primary research question: Which A&M skills will be needed by newly graduated physical therapists in the year 2010?


   Results
Top
 Abstract
 Introduction
 Method
 Results
Discussion
 Conclusion
 Appendix.
 References
 
Analysis of Participants' Responses for Differences Across Work Settings or Participant Roles

The chi-square analysis demonstrated no association between the 2 primary independent variables, clinical setting and primary role ({chi}2=5.28, df=3, P=.152) (Tab. 5). The subsequent 2x4 MANOVA found no differences between clinical and managerial roles on the average scores of any of the 6 FINHOP categories (F6,177=0.49, P=.816), no differences among 4 practice settings on the average scores of any of the FINHOP categories (F18,501=0.92, P=.55), and no interaction between clinical roles and practice settings (F18,501=1.23, P=.23). In addition, 1-way MANOVAs produced no differences among educator, clinician, and manager roles (F12,490=1.04, P=.41) or in the respondents' number of years of clinical experience (F36,1114=1.15, P=.25) on the average score of any of the 6 FINHOP categories. Because no differences were found in any of these analyses, responses from all 417 participants were combined for all remaining analyses.


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  		Table 5. Distribution of Therapists in Clinical Practice by Clinical Setting and Primary Rolesa

 
Determination of Skill Groups Within FINHOP Category Structure

The internal consistency of responses within FINHOP categories (Cronbach alpha) ranged from .87 to .98 (Tab. 6). These results are considered to be in the "very good" range, indicating good correlation among the responses within each category.20


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  		Table 6. Internal Consistency Reliability Coefficients of Administration and Management (FINHOPa) Categories

 
A total of 16 skill groups emerged from the factor analyses of the FINHOP categories. All items achieved a factor loading score of 0.50 or higher, and each item loaded on only one factor in both the exploratory and confirmatory analyses. As displayed in Table 7, human resources and operations each had 4 skill groups, finance and planning and forecasting each had 3 skill groups, and information and networking each had a single skill group. A fairly large portion of the variability in the data within each of the FINHOP categories was captured in the factor analysis procedure, with networking lowest at 53.5% and finance highest at 85.4%. The internal reliability coefficient (Cronbach alpha) of each skill group ranged from .76 to .99, indicating good to very good correlation among the responses within the skill groups and good discrimination among skill groups.20 The responses to individual skills within most of the skill groups demonstrated a great deal of variability in that the entire 7-point scale was utilized.


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  		Table 7. Factor Structure and Descriptive Statistics for 16 Administration and Management Skill Groups

 
Determination of A&M Skills Needed by Newly Graduated Physical Therapists in 2010

Median scores were calculated for each FINHOP category, skill group, and individual skill. At the category (FINHOP) level, a hierarchy of A&M skills began to emerge with human resource, information, and operations skills having higher median scores (5.3–5.6) than networking, planning and forecasting, and finance skills (4.6–5.0) (Tab. 6). The median scores of all 16 skill groups, which were derived from factor analyses, ranged from 4.3 to 6.5 (Tab. 8).


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  		Table 8. Administration and Management Skill Groups From Highest to Lowest Median Scores

 
Four skill groups (self-management, compliance, ethics and culture, and coding) exhibited median scores of 6.0 or greater, indicating that the new therapist should need only limited assistance in performing these skills and should have substantial knowledge about them (Fig. 3). Three skill groups (marketing and strategic planning, environmental assessment, and financial analysis and budgeting) demonstrated median scores of less than 5.0, indicating that the new therapist should need substantial assistance in performing the skills, but have limited knowledge about them. Finally, inspection of median scores of individual skills (Appendix) revealed that only 6 skills (listening skills, verbal and nonverbal communication, personnel licensure and certification requirements, professional ethics, documentation requirements, and time management) had a median score of 7, while 25 skills had median scores of 6. Of the remaining 90 skills, 61 had median scores of 5, while 29 had median scores of 4. No individual skill had a median score below 4.


   Discussion
Top
 Abstract
 Introduction
 Method
 Results
 Discussion
Conclusion
 Appendix.
 References
 
Using visual inspection, we found our sample to be remarkably similar to APTA's 2005 member distribution19 in terms of location of practice, type of entry-level physical therapy degree earned, highest degree earned, level of experience, and primary work setting (Tabs. 1, 2, and 3). This finding suggests that our sampling technique captured a representative group of physical therapists. Unlike previous research,16,17 we found that neither primary role nor type of work setting led to differences in any of the skill and knowledge ratings of the A&M categories. Thus, we were able to use the entire sample to learn more about physical therapists' expectations for new DPT graduates in 2010.

Because Lopopolo et al7 suggested that the Guide-based structure3 they used in their research may have confused their subjects while they scored A&M skills, in this study we used a new 6-category framework of A&M skills (FINHOP) that was based on a thorough review of business and health care management literature.15 Using level of independence in a skill needed at entry into practice as our primary measure, we found the taxonomy of A&M skills represented in the 6 FINHOP categories to be consistent with that found in the business and management literature. We believe that this taxonomy improves upon Lopopolo and colleagues'7 results.

FINHOP Category Analysis

When we examined the median scores for each of the FINHOP categories, we found that the new graduate would need to be moderately independent (median scores of 5 or higher) in performing the skills in 4 FINHOP categories: human resources, information, operations, and networking (Tab. 6). Only 2 of the 6 categories—planning and forecasting and finance—demonstrated median scores below 5. The variability of median scores among the FINHOP categories suggests a hierarchy among A&M skills expected of the new physical therapist, with human resource and information management being the most critical entry-level skills for future DPT graduates to possess. This hierarchy of A&M skill categories represents a departure from established APTA core documents3,6,29 as well as from the original LAMP model1 in that none of them provided a sense of the relative importance of A&M skills for new physical therapists. However, we found the category level of analysis to be too broad to yield meaningful suggestions for practical application of specific A&M skills. Therefore, we chose to statistically group skills within each category in order to draw more specific conclusions.

Skill Group Analysis

Unlike Lopopolo et al,7 who used professional judgment to identify 38 groups of A&M content, we discovered 16 skill groups using factor analyses to help us further examine the skills needed by new physical therapist graduates (Tabs. 7 and 8). These findings indicate that the new graduate would need to have a substantial level of knowledge about and be moderately to completely independent (median scores between 6 and 7) in performing skills in 4 of the 16 skill groups: self-management, compliance, ethics and culture, and coding. For skills in 9 of the skill groups, the new graduate would need to be moderately independent, but possess only a limited level of knowledge (median scores between 5 and 5.57). Finally, the new graduate would need substantial assistance in performing skills in only 3 skill groups (median scores below 5). These findings suggest that 13 skill groups contain A&M skills that should be included in entry-level DPT education programs and that a hierarchy of independence exists among these skill groups. However, the level of instruction and learning cannot be determined without paying attention to the individual A&M skills in each skill group.

Two skill groups—self-management and compliance—had the highest median scores, suggesting the highest levels of independence. They reside in the human resource and operations categories, respectively. Self-management includes skills in communication, stress management, complying with licensure requirements, and participating in role modeling and self-assessment for the job market, whereas compliance includes skills related to adhering to organizational policies and procedures and time management. Interestingly, most of these skills relate to how the individual conducts himself or herself and require reflection, as suggested by Jensen et al.30 Many of them also appear in the Guide3 and the Normative Model6 and in May and colleagues' Generic Abilities.4 Additionally, communication, interpersonal skills, and self-direction are identified as basic competencies in the Leadership Effectiveness Framework developed by the US Office of Personnel Management.31 Although these skills may not be unique to A&M content, their appearance at the top of an A&M list of skills, with individual scores of 6 or 7, suggests that DPT graduates will be expected to have mastered these skills prior to leaving the education program and, perhaps, need them as prerequisites for development of other A&M skills.

The ethics and culture skill group, which is part of the human resource category, demonstrated the third highest level of independence. This skill group contains 3 items with individual median scores of 6 or 7: activities that reflect adherence to professional and business ethics as well as to organizational culture. The high rating of skills in this skill group suggests that, prior to program completion, new DPT graduates will be expected to demonstrate appropriate ethical practice behaviors, which are at the core of professionalism. This result supports Lopopolo and Schafer's5 conceptualization of the underlying contextual role that professionalism plays in clinical practice as well as APTA's emphasis on the role of professionalism in its Vision 2020 statement.2 Like the skills in the higher-ranked self-management and compliance skill groups, the ethics and culture group focuses on behaviors related to the conduct of the individual therapist.

Coding, which is in the finance category, is the fourth highest rated skill group. It contains 4 skills that address use of coding systems to obtain reimbursement for services and is the highest rated skill group that belongs solely in the administration and management domain. Clearly, new DPT graduates are expected to be nearly independent and very knowledgeable in using the reimbursement coding systems required in various physical therapist practice settings. However, we suggest that determining what is taught should be guided by the scores of the individual skills within the skill group. Among the coding skills, for example, our results suggest that emphasis should be placed on teaching students how to use the International Classification of Diseases (ICD),32 Healthcare Common Procedure Coding System (HCPCS),33 and Current Procedural Terminology (CPT)34 coding systems, because all 3 skills had median scores of 6. The resource-based relative value system (RBRVS), however, had a median score of 5, suggesting that the graduate should possess a less thorough knowledge related to this skill than to the coding skills prior to entry into practice.

By contrast, the skills in the reimbursement review and analysis skill group, also within the finance category, demonstrated a lower combined median score (5.0) than those in the coding group (6.0). These median scores suggest that skills in both skill groups should be included in DPT education programs, although the amount of knowledge that a graduate should be expected to possess upon entry into practice would differ. All skills in the reimbursement review and analysis skill group demonstrated median scores of 5, suggesting they should receive equal emphasis in the DPT curriculum. The level of knowledge expected at entry into clinical practice is lower for reimbursement review and analysis skills, perhaps because they appear to be more complicated than merely learning how to use various coding systems and may well require a higher level of critical thinking to master. The lower median score may suggest that these skills are expected to be refined after the new graduate begins his or her first clinical position.

New graduates are expected to be moderately independent in performing the A&M skills in the information management, leading and directing, quality/risk management, practice analysis, personnel management (except for 1 skill), networking (except for 2 skills), operational analysis, and operational management skill groups, but are not expected to have extensive knowledge about each skill. These results suggest that all the individual skills within these skill groups should be addressed in DPT curricula with the degree of emphasis guided by the median score of each skill.

The new graduate was expected to need substantial assistance and have limited supporting knowledge upon entry into practice (median scores below 5) for skills in only 3 skill groups: strategic planning and marketing, financial analysis and budgeting, and environmental assessment. Here again a review of the individual skills within each group reveals that median scores were either 4 or 5 (Appendix) and that this information would be helpful in determining which skills to emphasize in the DPT curriculum. Using this type of analysis for skills in every skill group may assist educators in determining which A&M skills to include in their curricula and how much emphasis to place on them.

Interestingly, the Normative Model6 includes classroom instructional objectives requiring higher skill levels in the areas of financial management, establishing a business plan, and participating in activities related to marketing and public relations than would appear to be indicated from the results of this study. Thus, our study may provide useful information for future editions of the Normative Model. These findings may be even more useful to future renditions of APTA's recent Board of Directors–approved document on minimum skills required for new physical therapist graduates.29

Finally, we noted that the hierarchy of A&M skill groups based on level of independence tended to follow a pattern in which the highest expectations (median scores of 6 or 7) were placed on skills that related to the individual (ie, the new DPT graduate), with lower expectations (median scores of 5 or 6) often associated with organizational-related skills and even lower expectations (median scores of 4) associated with extra-organizational skills. Analysis of this unexpected pattern is beyond the scope of this study, but it offers an intriguing model for making decisions about what, when, and how the new DPT graduate should gain independence in various A&M skills.

Study Limitations

We identified 3 potential limitations of this study. First, although respondents were instructed to respond to each item in the context of what will be expected of DPT graduates in the year 2010, it was impossible to control whether they kept this instruction in mind as they completed the survey. Even if they lapsed into thinking about what is expected of today's new graduates, however, the results suggest that "future" DPT graduates will need to demonstrate proficiency in many A&M skills.

Second, the overall return rate of 17.4% for this questionnaire was low for a survey, although this result was anticipated because of the length of the questionnaire and the complicated scoring system. To compensate for an expected low return rate, however, we increased the size of the sampling frame to ensure that we had adequate power to carry out the desired statistical analyses.18 Third, the use of one scale to capture 2 constructs (skill and knowledge) may have limited the potential range of responses to level of knowledge available to respondents. However, using 2 separate scales, as in Lopopolo and colleagues' study,7 or expanding the scale beyond 7 points could have diminished the return rate further. Based on the assumption that the level of skill independence is the primary construct to be defined, we believe that the necessary level of knowledge to achieve a specific skill level should follow closely.


   Conclusion
Top
 Abstract
 Introduction
 Method
 Results
 Discussion
 Conclusion
Appendix.
 References
 
This study provides empirical evidence for the A&M skills needed by the DPT graduate. The variation in median scores among the 6 FINHOP categories as well as among the 16 A&M skill groups suggests a hierarchy of A&M skill acquisition for the new graduate physical therapist in 2010 regardless of practice setting. The results also provide information related to specific A&M skills that could be used to add specificity and priority in future editions of APTA core documents that address new graduate competencies. By understanding what is expected of future new graduates, educators will be better able to design and implement curricula that better prepare their graduates for clinical practice. Finally, the findings may provide guidance into what knowledge and skills physical therapists should further develop after they enter clinical practice, information that may be useful to educators who teach postprofessional courses for physical therapists and to APTA as it develops educational offerings at the national and component levels to develop skilled physical therapist managers.


   Appendix.
Top
 Abstract
 Introduction
 Method
 Results
 Discussion
 Conclusion
 Appendix.
References
 


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  		Appendix. Administration and Management Skills, Median Scores, and Their Definitions Organized by Category and Skill Group

aSkill groups as determined from factor analysis. Skills listed in order of median score within skill group. ICD-9=International Classification of Diseases, 9th revision, HCPCS=Healthcare Common Procedure Coding System, CPT=Current Procedural Terminology.

 


   Footnotes
 
All authors provided concept/idea/research design, writing, and data analysis. Dr Schafer and Dr Lopopolo provided data collection, project management, and fund procurement. Dr Schafer provided clerical support. The authors acknowledge the following physical therapist students who assisted with the pilot studies for this research: Aimee Ahrons, Ryan Long, Tikisha Thomas, and Tran Tran.

A summary of this research was presented at the Combined Sections Meeting of the American Physical Therapy Association; February 1–5, 2006; San Diego, Calif.

This study was funded, in part, by a grant from the Health Policy and Administration Section of the American Physical Therapy Association.


   References
Top
 Abstract
 Introduction
 Method
 Results
 Discussion
 Conclusion
 Appendix.
 References
 

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