ASEPNewsletter
Vol
2 No 1
January,
1998
ISSN
1097-9743
The ASEPNewsletter
is devoted to informative articles and news items about exercise physiology.
It is a monthly magazine of news, opinions, exercise physiology professionals,
and events that shape exercise physiology. While it contains views and
opinions of the Editor
who oversees the ASEP Internet Websites, visitors can have a voice as well.
We welcome interested practitioners, researchers, and academicians to e-mail
the Publisher their thoughts and ideas or to respond directly via the ASEP
Public Forum.
February,
1998
Licensure:
Questions
Exercise Physiologists Should Ask Themselves
Tommy
Boone, PhD, MPH
ASEP
President, Professor and Chair,
Department
of Exercise Physiology, College
of
St. Scholastica, Duluth, MN 55811
Non-PhD
exercise physiologists are interested in licensure. They think that a licensed
exercise physiologist would not have the problems they are facing, especially
in the clinical field. At this time, though, only the state of Louisiana
has licensure for clinical exercise physiologists. Several other states
are considering it, given the interests of the clinical professionals in
those states, and even one fitness organization outside of the sports medicine
field has asked its members to consider the pro and con of licensure.
Why
do exercise physiologists think that licensure is the answer? In theory,
licensure at the state level validates the assumption that the exercise
physiologist has acquired the knowledge required for safe performance.
Not passing the examination, for example, would eliminate the unqualified
and, therefore, protect the consumer from harm (the client specifically,
and the public in general). The reality, however, is that exercise physiologists
probably want licensure because they think will put them on the same level
(or status) with, for example, physical therapists or nurses, which leads
to the next question.
Will
licensure afford the similar status as is given to the physical therapist?
The answer is no. First, exercise physiologists need support from a professional
organization to think through the process and ensure that it is done right.
By this, I mean, the profession is not served well when good intentioned
professionals initiate licensure procedures in this state and that state
when the profession itself is not in on the process. It is simply too unorganized
to control the body without the head!
It
seems, first, that exercise physiologists should come together and unify
their efforts and work through logical debates about what is best for the
profession. Individuals frustrated with where they are in their practice
may achieve their goals faster when joining forces with other professionals
who have similar beliefs. Second, interested exercise physiologists should
agree to meet to define the specifics of what consititutes a college or
university (hereafter, college) academic program of course work in exercise
physiology (science) that will stand the test of national certification
(or licensure). Aside from the exercise physiologist's desire to be on
equal footing with other health professions, the perceived lack of respect
they receive, the obvious salary differences, and the lack of reimbursement
opportunities for services rendered, "Is there a problem of protecting
the consumer from harm and thus the need for licensure?
Are
all exercise physiologists equal?" The answer is no to both questions.
Again, many students graduate from college programs that are significantly
if not seriously flawed with academic weaknesses in exercise physiology
course work (both depth and number). Too many of these programs are designed
around the notion that two or three courses in exercise physiology is sufficient
to warrant an academically engaging concentration in exercise science (not
physiology). These programs are in the majority not the minority, yet the
students graduate thinking that they are exercise physiologists (and they
would be if the academic programs were better configured).
Because
there are academic programs that offer a degree (major) in exercise physiology,
and because there is so much emphasis on health, fitness, wellness, rehabilitation,
and athletics, all academic programs that offer a concentration in exercise
science should be moving towards a major in exercise physiology. It isn't
that hard to do if we had the support of the exercise physiologists who
teach throughout these programs. Until then, it does seem logical and correct
to conclude that the only BS exercise physiologist is the one who graduated
from a college that has an academic degree in exercise physiology. There
are a few in the United States. Logically, the number will increase as
more PhD-academic-exercise physiologists become more aware of the problems
of not having the degree presents to the graduate.
Hence,
there should be an agreed upon set of course work, hands-on experiences
(in anatomy, kinesiology, biomechanics, and exercise physiology laboratories),
and internship hours if exercise physiology is to continue to move effectively
towards professionalization. The consumer intuitively understands this
vital point as does the medical community. Some exercise physiologists,
however, at the BS and MS levels would concur that it is apparent that
too many academic PhDs in exercise physiology do not understand this point.
Perhaps, it is no longer possible to just do a good job of teaching classes,
publishing research articles, and attending national meetings to be considered
a complete professional. Professors must begin to think about their students
beyond the required courses and lab experiments. Not everyone is happy,
especially the students, regardless of the hard work to make the good grades
and then graduate, particularly if there are only a few good jobs to get,
while most jobs make it terribly difficult to survive financially. No,
many of the exercise science (physiology) students are hard pressed to
find that job their professors spoke of when in the kinesiology or exercise
physiology courses. Some have even asked the question, "What are the PhD
professors doing to help us?" It seems that the students are saying, we,
the professors, need to gain control of where we are, professionally speaking,
and regulate the profession of exercise physiology as other health care
professions have done, and that they believe it is realistic to do so with
certification than licensure.
Who
regulates exercise physiologists? That is, do we attempt regulation of
our profession by an organization with exercise physiology membership or
by an organization with many different and diverse members? The answer
is (or least should be) obvious. Exercise physiologists need to step forward
and voluntarily take the lead and the control to protect and to develop
the exercise physiology profession. They need to do this not just for themselves,
personally, but for their students who look up to them and who depend on
them to guide, mentor, and help beyond the college days. The professors
need to help the students understand that while certification, licensure,
and accreditation are important issues, they are not the immediate answers
to the problems faced by students. Exercise physiologists must first organize
themselves! For example, when the American Society of Exercise Physiologists
passes an agreed upon statement by its members (or by a committee of designated
members of ASEP) that defines required course work, exercise physiologists
everywhere may infer from the national certification examination that will
follow that the graduate is a qualified professional. Not only will the
graduate benefit, but the public (and the medical community) as well will
know what an exercise physiologist does as part of the exercise physiology
profession.
Why
is ASEP concerned with the title, "Exercise Physiologist"? Because the
professional title informs the public who we are and what we do. It is
that simple. It may not restrict other health care professionals from engaging
in what exercise physiologists do, but nonetheless it should establish
ownership that what they do is fully within their right to do it. Therefore,
given our credibility, credentials, and title that establishes our relationship
with the consumer (and I might add with the college administrators), those
who infringe, misuse, or dilute what we do can be held accountable.
Credibility
is defined and demonstrated by the exercise physiologist as having confronted,
developed, and carried out the requisite features of the ASEP National
Certification Examination for all graduates of approved (and at some point,
accredited) college exercise physiology (or science) programs. Again, the
integrity of the exercise physiology academic programs must be established
first, and then the national examination becomes like the icing on the
cake. Then, at some point down the road, ASEP members should consider the
need and inherent value in select members of the profession becoming licensed
given their areas of specialty. At this time, however, licensure should
not be a priority because of the specifics of regulation at the state level,
the costs and time involved in the process, and the fact that some states
are working to abolish licensing boards.
Equally
important, if we believe licensure is designed to protect the consumer
and, at some point in the relatively near future, the exercise physiology
(science) programs are academically superior to what we have today, then
exercise physiologists who think licensure is necessary (to balance the
health care professions playing field) may want to rethink their position.
Until then, we do have a problem. That problem is one of not being able
to document the quality of the exercise physiology (science) programs throughout
the colleges in the United States. As a result, without accreditation,
it is reasonably easy to understand why the outsider such as the medical
doctor, the nurse, the psychologist, or the physical therapist (who is
familiar with both the meaning and significance of accreditation in their
professional work) to hold the exercise physiology graduate in suspect
of knowing and/or fulfilling his/her professional responsibilities.
Will
professional licensure correct the problem of lack of excellent academic
preparation? The answer is no. Licensure is not necessary and may do more
harm if used to distinguish the academically and hands-on qualified from
the less qualified, particularly if it divides the profession into two
primary areas of study (exercise physiology and clinical exercise physiology).
In fact, adopting the legislation that Louisiana has done will not correct
the professionalization problem. Licensure without a serious academic program
that leads to a major in the field is a waste of time in the long run and
may, in fact, result in equally unprecedented restrictions in the field.
It is not the right step in the direction exercise physiologists should
go at this time. It is too restrictive (at this time) and may, as stated
earlier, be important only for a subset of professionals in exercise physiology
that ultimately may distract from the larger development of the profession.
Is
exercise physiology and clinical exercise physiology the same? The obvious
answer is no, but some students (and maybe more than a few PhD professors)
have forgotten that exercise physiologists are educated (or least should
be) to work in multiple work settings. Exercise physiology is neither clinical
exercise physiology nor is it just about exercise, aerobics, or even the
prevention (if possible) of certain diseases faced by the aging population.
Hence, the undergraduate student in exercise physiology should be exposed
to a comprehensive and engaging set of core courses. There should be sufficient
depth to warrant a comprehensive and holistic understanding. Then, at graduation,
the graduate of the program should be honored with the title "exercise
physiology" in the same way the nurses are acknowledged in their academic
field of study when they graduate. They don't have to wait until they get
another degree (such as a master's or a PhD) to refer to themselves as
a nurse, so why should the exercise physiologist wait? The problem, of
course, stems from the general understanding that the undergraduate exercise
science (physiology) programs are too inconsistent to know what the students
are getting from them. The larger problem is there appears to be no one
working on the first problem, yet students graduate in full faith that
they will have a job with respect. It will be important for the members
of ASEP to work towards accreditation no matter how big a hill they must
climb. Time is on their side, at least to a point. With accreditation,
both the student and the consumer can be assured of academic uniformity,
respectability, and integrity.
What
is required for accreditation? Professors from the different colleges that
offer academic concentrations in exercise science (physiology) should consider
the importance of coming together to discuss the complexity and difficulties
of beginning the process of re-configuring their academic offerings (programs).
Programs that simply cannot be re-configured must be identified and addressed
accordingly. Those that can should consider the importance of moving towards
a major in exercise physiology (not exercise science) and eventually moving
awaying from the emphasis track altogether.
Why
haven't exercise physiologists made these changes before now? The answer
is multi-dimensional. One, the reality is that many, if not most, simply
haven't thought about it. They have worked hard towards developing research
interests and application to the athletics and sports, rehabilitation,
and lifestyle matters. They haven't been caused to stop and think about
the philosophy of exercise physiology, the ethics of exercise physiology,
or the professionalization of exercise physiology. To my knowledge, there
are no workshops that deal with these kinds of issues. Course work is identified
much in the same way they were taught earlier somewhere else. They perform
their work in much the same way as earlier exercise physiologists, and
probably, many lost their way working too hard to develop sports medicine.
There are a lot of reasons. What is important now is that more exercise
physiologists at all levels are thinking about the profession and how it
can move ahead in its development.
Change
is inevitable, particularly in exercise physiology. We must consider it
imperative that we are at the beginning of significant programmatic revisions.
These changes must come from within the academic ranks, and especially
from the academic PhD exercise physiologists who, by their earlier work,
set the stage for why we are today. However, they need to now learn from
the students they taught just a few years earlier. They need to listen
to the BS and MS graduates and learn from their first-hand experiences
outside of the college environment. They need to know about the difficulties
the students are faced with. If they don't listen, the college administrators
will eventually come to understand the problems, and just around the corner
will come downsizing! Departments will get new names to continue afloat.
Cut-backs in programs, equipment, and ideas will eventually bring the big
engine to a stop. All of this will happen if the exercise physiology student
does not have a job with respect and enough money to surive.
Why
aren't the academic PhD exercise physiologists working to correct the problem?
Given
our infancy as a developing (semi-) profession, the short answer is that
the academic exercise physiologist may not have realized his/her responsibility
in this area. The students' emotional health and welfare is the business
of the college professors just as it is to ensure excellent academic preparation.
Members of ASEP hope to leave a legacy of concern for every graduate who
finishes an exercise physiology program. At the national level, bridges
must be built between colleges with exercise physiology programs, the faculty
who teach in these programs, and a better analysis and understanding of
the exercise physiology job opportunities throughout the United States
and worldwide must be initiated by the professors. ASEP is designed to
be a big part of these changes because it is an organization by and for
exercise physiologists at all academic levels (BS through PhD). ASEP, in
particular, is designed to help facilitate the development of certification
for the academically prepared exercise physiologist.
Why
is there so much discussion about licensure and so little about certification?
The answer lies in the views of a few exercise physiologists in the clinical
realm who understandably felt they had to do something to get the ball
rolling. Unfortunately, it appears that no one ever thought about exercise
physiology certification per se. To certify the exercise physiologist would
mean that he/she had to be exposed to a rather engaging academic program
of study. Maybe, no one (strangely enough) thought that the exercise science
programs warranted a good enough product to move towards certification.
Hence, why not do it then within the context of a sports medicine organization?
Unfortunately, this particular direction moved away from the emphasis that
should have been placed on academic programs and set the profession of
exercise physiology back a few decades!
The
bottom line is, exercise physiologists have the right to their own certification
via their own professional organization. The certification should represent
the years of academic study at the college level. Hence, while academically
prepared exercise physiologists may be certified as an exercise specialist
(should they decide to do so), the person who decides to become a certified
exercise specialist (without the college-level exercise physiology academic
preparation) is not an exercise physiologist. In that the certification
should testify to the academic status and professional competence achieved
by the college graduated exercise physiologist, ASEP is dedicated to developing,
supporting, and supervising the certification of the academic exercise
physiologists (whether at the BS, MS, or PhD level). The problem of lack
of interest in the professionalization of exercise physiology has been
ignored too long as well as the downstream difficulties it has caused.
ASEP
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