The Professional
Amalgamate: A Ponderance
J. LANCE TARR, MS, CSCS
Exercise Physiologist
and ASEP Professional Member
Degreed,
certified, registered, licensed.... all terms alluding to an individual’s
expertise, a certain competence in the practice of a profession, trade,
or art form. By comparison, institutions, facilities, and/or programs often
seek accreditation as a statement of meeting specific standards set forth
by authorities in their respective fields. Agencies, organizations, and
commissions are all examples of accrediting administrations.
Questions may frequently
arise concerning just what qualifies as a “profession” and what constitutes
being a “professional”. What is the difference between a “job”,
a “profession”, a “vocation”, a “career”? And, of
course, there’s the not so subtle difference between being employed as
a legitimate professional vs. conducting oneself professionally (thing
vs. action). Questions referencing worker monikers also enter the picture....
is one a professional if one is certified, but not degreed.... degreed,
but not licensed.... licensed, but not certified.... degreed, certified,
but not registered or licensed?
For the sake of discussion,
a clarification of terms appears appropriate in order to assure consistency
in exchange. As I polled some of my colleagues, I found varied responses
to the above questions. I am employed in a physical therapy department
and, therefore, spoke with physical therapists, athletic trainers, and
exercise physiologists. The questions I posed were straight forward. What
is the difference between a vocation, an occupation, a career, and
a profession? What constitutes a bonafide profession? Are all who work
in a profession, then considered professionals?
The discussion was enlightening.
Vocations were thought synonymous with occupations in that a fee is received
for a service rendered, regardless the level of expertise required.
One therapist expressed that a true profession is one in which higher learning
is required and a bill for specific services can be submitted directly
to the patron of those services. In reference to healthcare professionals,
one therapist felt that a license requirement defined the difference between
a professional and a non-professional. The therapist went on to state that
those with degrees and higher certifications in their respective health
care fields, but no licensure requirements, could be considered ‘’para-professionals’’
or possibly technicians. Another felt that, at least in clinical health
care, if one could ‘’hang out a shingle’’ and treat the public without
a physician’s order, then that qualified them as a professional. Behavior
of a professional centered around one’s effort to be ethical in patient
treatment, adhering to professional codes, as well as on the job interaction
and making continuing education a requirement for continued practice of
one’s field.
Webster’s defines profession,
in part, as: A calling requiring specialized knowledge and often long
and intensive academic preparation. It defines professional,
in part, as: Characterized by or conforming to the technical or ethical
standards of a profession; engaged in by persons for receiving financial
return. Career is defined, in part, as: a field for or pursuit
of consecutive progressive acheivement esp. in public, professional, or
business life; a profession for which one trains and which is undertaken
as a permanent calling. Degree is defined, in part, as: A
title conferred on students by a college, university, or professional school
on completion of a program of study; an academic title conferred to honor
distinguished achievement or service. Certificate is defined,
in part, as: A document certifying that one has fulfilled the requirements
of and may practice in a field. License is defined, in part,
as: Permission to act; freedom of action; permission granted by competent
authority to engage in a business or occupation or in an activity otherwise
unlawful. It defines registered, in part, as: qualified formally
or officially. And finally, it defines
accredit, in part, as:
to
consider or recognize as outstanding; to give official authorization to
or approval of; to provide with credentials; to recognize (an educational
institution) as maintaining higher standards that qualify the graduates
for admission to higher or more specialized institutions or for professional
practice.
For the sake of discussion
(within this article) I will stay within the latitude of the above definitions;
however,
the reader should note that by definition, exercise physiology
does actually qualify as a profession and those attaining the degree
meet the aforementioned definition of professional. Whether
it qualifies as a career by definition is open to debate for any
number of reasons. Therefore, how we are perceived, and indeed, how
we perceive ourselves matters probably more significantly than we’ve cared
to think about in the past.
Much of what we will be “permitted”
to do, as well as much of what we try to achieve lies in perception. Perception
is rarely, at least initially, formed from objectivity. It is often a “what
you see is what you get” or “ a book judged by its cover” assessment. In
other words, if an individual EP’s actions are unprofessional and/or unethical,
or his/her knowledge-base is less than scholarly, then the discipline itself
is generally viewed as less than professional. Because our field is so
diverse in terms of areas of study, it seems that this may at times be
one of our greatest weaknesses. I refer to the fact that we are the only
discipline well-versed in health, wellness, exercise, fitness, rehabilitation,
and performance-oriented training. As “turf “ issues are ever prominent
in these fields, our focus must be in unity, attainment of professional
integrity, and following through with individual professionalism.
So what do we do? Before
this author delves into generalities and our ASEP’s current course of action,
I would like to relay just a few of the personal professional issues which
have recently come to bear in my department. A memo was recently circulated
from our the Director of Physical Therapy Services which read, in part,
as follows:
"Our staff in the
physical therapy department is comprised of individuals with various educational
backgrounds and expertise including physical therapists, athletic trainers,
and exercise physiologists. It is critical that we utilize the skills of
each individual in ways that are both legal and ethical in terms of delivery
of physical therapy services. The roles of exercise physiologists and athletic
trainers in a PT clinic have come under close scrutiny over the past several
years from a legal and ethical perspective. In order to adhere to the West
Virginia Physical Therapy Practice Act as well as the recommendations of
the American Physical Therapy Association (APTA), the athletic trainers
and exercise physiologists will work under supervision of the physical
therapist responsible for each patient’s care. This means the EPs and ATCs
will work within their knowledge base to assist with patient care, but
the treating PT will be responsible for guiding the patient’s treatment
and documentation. It also means that treating PT will be present in the
clinic any time the patient attends a physical therapy session. Scheduling
will be arranged for outpatient, industry, and sports/aquatics departments
in order to be certain this occurs."
From an actual job responsibility
aspect, this lightens an EP’s or ATC’s burden significantly; however, from
a professional standpoint, it says something. In addition, I noted
a memo sent to our department from the Ohio Bureau of Workers Compensation
which read:
“Any reports signed
by unlicensed health care providers will result in the reimbursement cost
being denied.”
In a recent issue of
Advance for Physical Therapists and PT Assistance (August 31,
1998), pg. 6 polled various PT’s on the question of “What should
be done about the predicted PT surplus?” One PT replied: “A surplus may
enable us to get into under-served areas such as rural or inner city facilities.
Or how about PT’s getting into health and wellness, preventive aspects
of health, ergonomics, industrial care, back into respiratory care, TMJ
and working with dentists, foot care, sports management, cardiac care,
or going back to school to become teachers or researchers? I have seen
ATCs, kinesiologists, and just general ‘’exercise technicians’’ run programs
that we should be managing but haven’t been mainly due to our lack of manpower,
yet I also suggest our lack of ingenuity.” Still another replied, “The
profession of physical therapy should immediately stop the loss of areas
of our profession to other health care professions and regain those areas
we have lost. We have lost the upper extremity to the occupational therapists,
the lungs to respiratory therapists, the heart (cardiac rehab) to exercise
physiologists [this author begs to differ.... perhaps its been lost to
the RNs, but certainly not to EPs], and the athlete to athletic trainers.
Kinesiotherapists want therapeutic exercise, ATCs and EPs want industrial
medicine, and massage therapists and chiropractors want manual therapy.”
The point being that we are,
and will, experience much opposition to our professionalization due to
strong lobbies from other disciplines, not just physical therapy. As noted,
nurses, athletic trainers, respiratory therapists, occupational therapists,
and a whole host of other clinical professions are keeping a watchful eye
on exercise physiology as we struggle for recognition. I note also that
these professions already have established credentials and acceptance in
the clinical fields through licensure, strong organizations, and AMA recognition
as viable professions. The lobbies which represent these organizations
will not look favorably on territorial encroachment, so rest assured, our
efforts must be from a unified, ethical, and professional plane.
In their article, The
Licensing of Exercise Physiologists which appeared in the February
1997 issue of Fitness Management, LaGary Carter, D.A. and Coby Bentley,
B.S. wrote: “Exercise physiology is something of a profession in limbo
as some states license (and limit) its practice while debate continues
on its appropriate role in health-care and fitness.” Two definitions of
an exercise physiologist are in existence. One is from the U.S. Department
of Labor’s Dictionary of Occupational Titles, while the other is
the American College of Sports Medicine’s (ACSM) which is further
divided into two categories: exercise physiologist and clinical exercise
physiologist. I believe our organization has also added to the list of
definitions. When contemplating certifications, licensures, accreditations,
etc. the definitions and professional responsibilities of each facet of
exercise physiology will need to be considered. In addition, what will
be the steps toward such actions and which areas need to happen by way
of priority before other the other areas follow? Do we accredit programs
first? Do we certify before license? Do we certify all and license only
clinical EPs (in effect, licensing a job, not a discipline)? What happens
if separate state organizations, independent of the ASEP, legislate and
gain licensure requirements for the practice of exercise physiology within
that state? Indeed, Louisiana has already done such and other states are
attempting such (my own included).
The problems are, of course,
the independence vs. unity issues, as well as where do we start? The ASEP
has a vision and the tools emerging to address such issues. Though I do
not agree 100% with the sequence of priorities as set forth by our national
organization, I am nonetheless committed to unity and being as involved
as necessary in order to attain our goals of professional acceptance and
standing. I note that Dr. Boone and I have had brief exchange on sequential
priorities with the ASEP’s direction as follows:
1) Academic program
accreditation;
2) Certification of graduates
via an assessment exam; and
3) license for specific
entities of work (particularly clinical).
I believe that the following
would be more professionally enhancing:
1) Academic program
accreditation;
2) National registry exam;
3) Licensure testing for
all EP’s passing the registry; and
4) Certifications in various
areas such as cardiac rehab, pulmonary rehab, orthopedic rehab, industrial
medicine, sports medicine, fitness, personal training, wellness, etc.
I will save those arguments
and defense of my views for a later article.
In closing, I do not wish
to leave the reader with the thoughts that I am anti-other professions.
I am not. I view my colleagues (PTs, ATCs, etc.) with the utmost respect
and appreciation. My wife is a respiratory therapist. I have worked with
RNs in Cardiac Rehab. I have had occasion to interact with nutritionists,
dieticians, massage therapists, and respiratory therapists in a professional
capacity and can attest to their knowledge, expertise, and behavior as
beyond reproach. We, both as individuals and as a collective discipline,
need to be at our professional best at all times in order to earn the same
respect in return, as well as further our cause of recognition, unity,
and in the long term, employment as professionals.
The reader, if an exercise
physiologist, needs to contemplate some other questions, as well. They
may fall close to home. If an EP’s lifestyle is not one which emulates
health and wellness through action, is he/she professional? If an EP does
not secure quality certifications in their respective areas of employment,
is he/she professional? If an EP is not attending conferences, seminars,
etc., or at least reading current literature and research pertaining to
the field in order to provide quality service, is he/she professional?
And finally, if an EP does not belong to a relative professional organization
and/or is not proactive in attempting to make professionalism happen in
the field, is he/she professional enough to deserve the title? I leave
you with these questions to contemplate and hope your involvement is of
a positive and most active nature.
