Editorial
The Quest for Licensure and the Loss of
the Holy Grail
Eric Durak, MSc President of Medical Health
and FitnessSanta Barbara,
CA
Tonight
I find myself reading the latest article on licensure for exercise
physiologists (ASEP Newsletter, Vol. 10, October, 2007) from Mr. Johathan Mike
from the University
of New Mexico, and find
myself again explaining the realities of licensure for the profession of
exercise physiology from my perspective.
This
perspective is fairly sound, as in 1988 (almost 20 years ago), I served on the Southwest ACSM ad hoc committee on professional standards
for exercise physiologists. A group of
health care professionals from hospitals, VA systems, and clinics in the
southwest US spent a considerable amount of time over years putting together
information on accreditation status for the profession. Up until the year 1991, the concept did not
move forward. That
year, a professional trainer (and Master’s trained exercise physiologist) from
the San Francisco Bay Area put together a state senate bill to license personal
trainers. Her rationale was that personal
trainers posed a risk to the public because they had no health care training –
and therefore licensure would assure minimal competency. The ACSM – the organization she was trying to
represent in this mission was one of the first groups to attend the state
senate committee meeting and publicly rebut her attempts to license
trainers. Their rationale is was that
the ACSM was not an organization of personal trainers, and could not endorse
such a bill. It never made it past the
committee.
In
1993 I personally wrote and presented a scope of professional practice for
clinical exercise physiologists at the ACSM national conference in Seattle, WA. It was lauded by ACSM clinical members as a
tremendous piece of work – but when it was submitted to the ACSM journal – it
was promptly rejected.
In
1994 the State of Louisiana
passed a bill licensing clinical exercise physiologists. Passing their state legislature by a “pro EP”
senator, it seemed as though the bill would be the first of many such bills
submitted to states across the US
– now that the template had been put together.
A few of the EPs in the state that I new were initially excited about
the bill, as they thought they would receive reimbursement dollars for more
cardiac rehab visits, and for other clinical services, such as worker’s
compensation rehab, etc. Over the course
of just five years, the number of EPs who renewed their (expensive) licensure
status dwindled.
In
a phone call to Mr. Rob Streeck of the Ochsner Clinic in New Orleans, he stated
that there was no reimbursement for any EP service (the Louisiana PT
association made sure of that), and that the paperwork and expense of licensure
status made it improbable to maintain the status. Did the public he serve (he is one of the
nation’s top clinical EPs) know the difference?
Not really. They knew the cardiac
rehab “team” had great service, and that Rob’s department was one of the best
post rehab providers in the area. To
date there is no real push to use the Louisiana
bill to further the licensure status in any state. To my knowledge – bills in Massachusetts,
Maryland, and Florida did not make it to state committees.
In
1995 a personal trainer from Los Angeles, CA spent the better part of two years
putting together a licensure bill for trainers that essentially looked a them
as post rehab providers (in the eyes of the state). This bill had the backing of many medical and
EP professionals who met via conference call over this time frame to work the
bill to prepare it for state approval.
However – the ACSM and other organizations were quick to point out that
since EPs were not included in the bill – then it wasn’t pertinent to the
interests of the organization. The
bill’s sponsor, Mr. Wobe Ofori stated that in the eyes of the public – trainers
may pose more of a “risk” of injury or harm then a college prepared EP. The bill was killed by the California PT
Association before it even made it to committee (D. Powers, personal
communication, 1997).
Over
the past 15 years the ACSM has had no interest in licensing exercise
physiologists – it is not in their charter (as ASEP director Tommy Boone points
out – they are not an association of EPs).
It
is also my opinion that perhaps ALL EPs – and most personal trainers pose
little or no risk to the public. This
has been explained in great detail by Senator Diane Watson from Los Angeles (1996), and
other political professionals who position bills for the health care
world. Since there is little evidence of
persons dying at the hands of trainers, and very few injuries directly
attributable to working with trainers (or EPs), then it is not an issue that is
of interest to legislators.
Mr.
Mike states that a lack of conformity in academic preparation is the big reason
that EPs are not licensed. If clinical
EPs perform an internship and professional experience in their chosen area of
work – what initial academic program they came from is less of an issue than
their current competencies. Mr. Mike
should look at PT web sites such as Rocky
Mountain University
(www.rmuohp.edu) to see that PTs who wish
to earn a doctorate in physical therapy can simply do coursework online, and
attend a series of seminars. I’m certain
that it’s more complicated than that – but in essence in every profession the
academic preparation will eventually take a back seat to clinical
experience. Most nurses in the US do not hold
a BS degree in their field. In the past
seven years there have been a plethora of reports on physician errors that have
caused injuries and or deaths (over 100,000 in 2001 according to JAMA). Medical mistakes are now part of physician
continuing education courses for most branches of physician practice. They are also becoming standard fair for
Registered Pharmacists. All of these
professionals are licensed.
The
real issue here is money. I have spoken
about this for over 15 years at national conferences, and in my book on medical
insurance billing is specifically for fitness professionals. The ability to earn money through medical
referrals, and to work with licensed professionals (such as physicians) to bill
through their practice has ALWAYS been available for EPs. In fact – there are a host of personal
trainers who are making a six-figure salary in clinical exercise because they
have learned the tools of billing procedures, and have negotiated contracts
with health plans, and employer insurance groups. One shining example of this is Mr. Bob Bovee
of Rochester, NY – whose wellness and fitness company (www.PersonalHealthApproach.com)
negotiates with large employer groups for big money contracts for clinical
exercise services. I have spoken about
his great work for many years and gently push other health professionals to
learn the aspects of contract negotiation to improve their bottom line – or to
increase the income opportunities for their medical department.
The
obesity epidemic and other chronic health related issues in the US rely less on
professional status than on the political whim of the day. There is a LOT of money available for obesity
prevention and treatment programs across the US.
The persons getting the funding are behavioral scientists,
psychologists, and others savvy on the aspects of getting these large grant
programs. I have seen no reports in ASEP
on how EPs can work toward obtaining these many funding sources.
The
challenge in the coming decade lies less in standardizing all academic exercise
physiology programs (it won’t happen), or wasting precious resources from ASEP
in pursuing licensure state-by-state (which has been attempted over the past 19
years, and has gone no where). The real
issue is to look to areas where EPs can make the best impact in clinical settings
while also improving the odds of enhancing income status through contracts,
referrals, and reimbursement.
This
is the essence of clinical exercise physiology.
I know based on my 20+ years in the profession that EPs already possess
the skills necessary to make huge impacts in healthcare – with the advent of
more weight management, bariatrics, cancer, arthritis, and senior wellness
programs (to name a few), there are still plenty of opportunities available for
EPs to gain respect and credibility in healthcare.
*He is a consultant and clinician in the area of
clinical exercise, and directs the Cancer Wellness continuing education program
nationally. He also serves as the
Wellness Supervisor for the Injury Reduction and Prevention program at the University of California. He may be reached at edurak@medhealthfit.com. 805-451-8072.