Part 1. Payment for Clinical Education Experiences: A Historical Perspective

Abstract

Background and Purpose: Payment for clinical education (CE) experiences in health care professions has been discussed for many years. Clinical education sites may consider requesting payment to offset expenses, which might include onboarding costs or perceived or real reduction in productivity. The American Council of Academic Physical Therapy–National Consortium of Clinical Educators Task Force on Payment for Clinical Experience explored the history of CE as it relates to payment, costs, productivity, and incentives through this comprehensive literature review. Methods: The literature was exhaustively searched through multiple data bases, compiled, and summarized by the authors. Results: Clinical education is an essential component of physical therapy education. The proliferation of academic programs combined with reimbursement challenges and increased productivity requirements has increased the burden of CE on health care facilities. Research in health care professions has investigated direct and indirect costs of providing CE experiences. While some research showed decreases in productivity while supervising a student, most research in physical therapy revealed increased productivity along with improved quality of care and enhanced recruitment of employees. Motivators for educating students in the CE environment included intrinsic factors of enjoyment, professional obligation, and intellectual stimulation; extrinsic factors such as continuing education credits, discounted courses, and academic appointments were also found. Research revealed that students bring value and enthusiasm to the CE environment in a variety of ways. Payment for CE experiences, more common in physician assistant, medicine, and nurse practitioner education, did not always improve quality and may be unsustainable as competition for clinical experiences grows and student debt increases. Discussion and Conclusion: Clinical education involves many stakeholders and the topic of payment is multifaceted. This comprehensive literature review highlighted numerous challenges and benefits for providing CE experiences as it relates to payment. This literature review provides background information regarding payment for CE in health care professions and served as foundational work of the Task Force on Payment for Clinical Experience for determining current perspectives related to payment for CE in physical therapist education.