State by State Course Approval and Credit Requirements for PTs and PTAs

Is this course approved in my state and how many credits do I need?

For Physical Therapists (PTs, MSPTs, DPTs) and Physical Therapist Assistants (PTAs) in the United States

by Dr. Brent Brookbush DPT, PT, MS, CPT, HMS, IMT

Why is Continuing Education Course Approval so Confusing for PTs and PTAs?

This question is another example of how accreditation, continuing education course approval, and education quality assurance is failing to serve educators and clinicians. If a person does not work for a national continuing education company, it is ridiculous to expect them to understand how course approvals work (although, we hope this article answers many questions). Unfortunately, in the USA, continuing education course pre-approval and license renewal are regulated by state chapters for physical therapists (PT, MSPT, DPT) and physical therapy assistants (PTA). This means each state has its own guidelines, regulations, and rules.

• Important Note: Neither the American Physical Therapy Association (APTA) nor the Federal State Board of Physical Therapy (FSBPT) handles continuing education course approval. Strangely, many state approval guidelines refer to the APTA or FSBPT. Again, course approval is handled by individual state chapters. This is a confusing loophole that should be closed.

State-by-state course approval is contradicting a trend in continuing education to favor national and international education companies (as opposed to local providers). Many of these companies operate as virtual companies without a local presence. The trend toward national and international education companies is a huge win for the industry, with larger companies offering a wider variety of higher quality courses, iterative improvement of courses based on feedback from larger groups of students, more flexible offerings (including in-person, live-stream, online), and often much lower prices. Unfortunately, there are also online course offerings that look like legitimate continuing education, but fail to acquire the accreditations necessary to ensure PTs and PTAs will receive credit during license renewal.

The unfortunate result is many PTs and PTAs become skeptical about whether their state accepts a course. And, they probably should be, as some of the lesser education companies do not invest in course approvals for more than one or a couple of states. Now, the Brookbush Institute , and a few other national education providers have the approvals necessary to ensure all courses are approved in almost every state, but that is not the standard. In the spirit of transparency and trying to help, this article shares what we have learned in our nearly 10 years of building an accreditation/course-approval portfolio, and our strategy for achieving "national-like approval" for PTs and PTAs. We even created tables below to show which approvals are necessary for your state to accept courses during license renewal. Our competitors could likely use this article to achieve similar "national-like approval", and compete with us head-to-head. But, we would rather achieve success through superior education and continue to reduce our colleague's confusion.

Additionally, we have added a list detailing the number of credits a PT or PTA needs for license renewal, by state.

Caption: Calling out the APTA and FSBPT: Will they do something beneficial for the industry after the ProCert debacle?

Calling out the American Physical Therapy Association (APTA) and the Federal State Board of Physical Therapy (FSBPT):

It would be nice to think that the APTA and FSBPT were built to support our profession; but, the reality is they are probably a not-for-profit in name only, truly functioning as a membership model business with additional high-end products in the form of "specializations". That sounds harsh, and we want to believe in the APTA and the FSBPT, but their track record for supporting the profession has some serious scars. One of those scars is ProCert by FSBPT. ProCert was an attempt at a business that would provide national pre-approval for continuing education companies offering courses for PT and PTA license renewal. Unfortunately, ProCert went out of business in 2019, costing the education companies they attempted to serve millions of dollars. What is truly unfortunate, is the idea was the right idea, but development and management were horrible. In particular, the director, who has also been involved in some of the most problematic state chapters, seemingly had little understanding of instructional design, course creation, education business models, efficient and accurate assessment (valid, reliable, sensitive, specific), controlling business costs, problem-solving skills, developing an organization for iterative improvement, etc. In essence, the director lacks all of the skills necessary to be an effective executive. What the director did create was an incredibly complex, unreliable, cumbersome business model that couldn't change or improve as expenses ballooned, and eventually collapsed the business. Amazing what you can get with a little ego, an air of infallibility, and perhaps complete ignorance of- or apathy toward education companies. In the few conversations we had with this director you would think he actually hated continuing education companies.

So where does this leave our profession? We call on the APTA and FSBPT to use this article as a foundation for a national continuing education course approval service. We will be adding additional articles in the near future that discuss how accreditors and continuing education course providers could build more effective and efficient services. Our recommendations are not based on personal wants, needs, or ideas, but rather on sharing the experience learned from attaining more than 2 dozen approvals and accreditations. We are confident that a combination of the best-practices from these organizations, would result in the most effective, efficient, and successful continuing education review program in allied health. All it takes is starting with the table below (to achieve national approval), using our resources to build a successful framework (to ensure efficiency and efficacy), perhaps hiring a good director, and ensuring that the business is built on modern management philosophies to ensure continuous improvement. We know this is a project that the APTA could successfully complete. They may need to spin off or discontinue their questionable conflict of interest (specializations), but if they are dedicated to serving our profession, this is absolutely the right move.

Caption: Map of states that accept Brookbush Institute continuing education courses for physical therapists and physical therapy assistants.

Understanding Credit Approval

The Key is Reciprocity (Quick Summary):

The key to national approval is the states that accept approvals from states or organizations with strong review processes already established. Believe it or not, most states have stipulations for reciprocity in their guidelines. If a continuing education organization has been approved by the following states and or organizations, they are covered in 45 of 50 states (you can see the 45 states covered on our coverage map above), and this number can likely be expanded to 50 of 50 states if you consider petition and practitioner submission when audited reasonable. Course approval by either California, Texas, or New York alone, would cover about 40 states.

• California
• Texas
• New York
• National Athletic Trainers Association - Board of Certification (NATA-BOC)
• American Occupational Therapist Association (AOTA)

Coverage by California, Texas, and New York is especially advantageous for large education companies. For Texas and California, following 3 years of individual course approvals without issue, an organization can apply for "institution approval". Institution-level approval results in the acceptance of all courses from that institution for a flat fee, with a yearly audit of a randomly selected course. We believe this is likely the ideal model for quality assurance and the continued growth of continuing education. This model results in institution-level approval following 6 - 12 months to get the first course approved, plus 3 years of course approvals without issue, and likely another 6 months to apply and be granted institution-level approval. That implies about 4 years of quality business development, and the audit of a randomly selected course promotes strong company-wide quality assurance practices. Although it may be argued that individual course review is ideal, it is also prohibitively expensive, and costs scale as companies add courses. Those expenses are passed on to students. This hybrid of initial individual course approvals, followed by institution approval with random audit, is likely the ideal balance between benefits and costs. New York starts with institute-level approval and the audit of a randomly selected course. The application is definitely challenging, expecting significant quality assurance processes in place prior to approval. However, as a physical therapist and educator, I do think that the systems used by California and Texas are likely to have a larger positive influence on the average quality of courses.

The Wierd

6 states will accept course/organization approval from either or both the National Athletic Trainers' Association - Board of Certification (NATA-BOC), or the American Occupational Therapy Association (AOTA). Obviously, this is strange because these organizations approve credits and licensure for separate professions; however, these organizations likely enforce higher quality standards than most, if not all state chapters and boards of education approving physical therapy courses. Further, the overlap in scope of practice between physical therapy, occupational therapy, and athletic training should make us wonder why we are separate professions. (Yet another subtle mention of my dream to create an integrated movement profession).

• DC
• Virginia
• Deleware
• Rhode Island
• Idaho
• Georgia

The "Whatever" States

9 states do not require course approval, and/or do not require that practitioners submit continuing education credits to maintain licensure. Before we criticize these states for failing to enforce lifetime learning, it may be worth considering whether course approval is actually having the desired effect on the quality of practice, especially if we were to judge course approval initiatives following a cost/benefit analysis. The ProCert program by FSBPT (mentioned above) did more than just fail, it dragged many companies into a completely ineffective, labor-intensive, and expensive, instructional design review, that likely had little impact on the overall quality of courses in the industry. Passing ProCert approval was more about learning what ProCert wanted to hear and less about improving the quality of courses. Although states without course approval or continuing education requirements fail to enforce quality standards, they also do NOT add to educator and practitioner expenses, and they leave the door open for a national course approval service.

• Alabama
• Iowa
• Kansas
• Louisiana
• Maine
• Nebraska (based on email correspondence)
• New Hampshire (made reference to recognizing "evidence-based courses" in an email correspondence with the New Hampshire State Board of Physical Therapy)
• Washington
• Massassachusettes

The Bad, but Manageable

• West Virginia
• Ohio

These two states do not have specific guidelines for reciprocity, meaning they are trying to pressure education providers into paying very high per-course fees for approval; however, they do have petition guidelines. This implies that if you are one of the unlikely few to have your continuing education credits audited following license renewal, you would have to submit additional paperwork. Our experience awarding credits to 10s of 1000s of students has been that audits are very rare, and when audits do happen these steps usually follow. It is an annoying process, but not difficult, and definitely manageable.

1. The practitioner receives the notification of the audit, with a request for proof of course attendance, or a list of submitted courses that require further review.
2. If the course is approved by another state chapter then additional information is requested by the auditors.
3. The clinician requests the information from the education provider. Any educator with course approval or accreditation experience will have this information readily available (e.g. behavioral objectives, lesson plans, course schedules, bibliographies, course creator credentials, etc.).
4. The education provider supplies the student with the requested information.
5. The student submits the additional information, the course is approved, and the audit is over.

Three states do not specifically stipulate petition guidelines; however, their guidelines suggest that a practitioner can submit a course for review, for free. This is odd considering they request a small fortune from course providers. If you are an education provider, NJ course approval is $100/course for 4 years, MD course approval is $50/course for 4 years, and NV is $10 - 50/course for 1 year. This implies the Brookbush Institute (165+ courses) would pay more than $31,000.00 for course approvals, every 4 years, just for PTs and PTAs in these 3 states. Or.... clinicians can submit the courses for free. I am not sure how that makes any sense, but that is their current guidelines. Course submission is similar to steps 3-5 of the audit process. Again, a little annoying, but not difficult.

• Maryland,
• New Jersey
• Nevada

A Legal Route to National Accreditation:

I need to mention I am not an attorney, this is not legal advice; this is only a thought experiment. If you considered using the assertion I am posing here as a defense strategy in an actual court case, I implore you to first seek advice from a lawyer with experience defending medical professionals. Also, I should mention that I would hate to see any professional unnecessarily pulled into a lawsuit, or unfairly obstructed from practicing.

This little thought experiment starts with the idea that preventing somebody from earning a living is actually a very serious matter in a court-of-law. That is to say, courts do not generally allow frivolous obstructions to an individual's ability to make a living. With that being said, I do think it would be an interesting case if a state were to try to suspend or revoke a PTs or PTAs license based on the submission of courses that were reviewed and approved in one state, but not in the practitioner's state. That is, the course had been reviewed and approved by a professional organization, demonstrating a minimum standard of quality, but the state chapter did not financially benefit from the review, so they suspended the practitioner. I think this type of suspension may be grounds for a lawsuit by the practitioner. If that lawsuit was won by the practitioner, implying that a state could not suspend or revoke a license based on a course audit that demonstrated a course had achieved approval from a relevant professional organization, course approval by any state board would then become national approval by legal precedent. Obviously, I would love to get advice from any attorneys who happen to see this article, and/or any practitioners, education providers, or organizations who have further insight into this issue.

The Number of Contact Hours Required for PTs and PTAs by State:

• Alabama: 10 hours per year by September 30th
• Alaska: 24 hours per 2-year period, by June 30th of even years
  
• Arizona: 20 hours per 2-year period, by August 31st of even years
  
• Arkansas: 20 hours per 2-year period, by December 31st of even years
  
• California: 30 hours per 2-year period, by the last day of the license holder’s birth month
  
• Colorado: 30 hours per 2-year period, by October 31st of even years
  
• Connecticut: 20 hours per year, by the last day of the license holder’s birth month
• Delaware: 30 hours per 2-year period, by January 31st of odd years
• Florida: 24 hours per 2-year period, by Nov 30th of odd years
• Georgia: 30 hours per 2-year period, by December 31st in odd years
  
• Hawaii: 30 hours per 2-year period, by December 31st in even years
  
• Idaho: 16 hours per year, by the license holder’s birthdate
• Illinois: 40 hours per 2-year period, by September 30th in even years
  
• Indiana: 22 hours per 2-year period, by June 30th in even years
  
• Iowa: 40 hours per 2-year period, by the 15th day of the license holder’s birth month
  
• Kansas: 40 hours per 2-year period, by December 31st in even years
  
• Kentucky: 30 hours per 2-year period, by March 31st in odd years
  
• Louisiana: 30 hours per 2-year period, by March 31st in odd or even years (based on the license holder’s birth year)
• Maine: No CEU requirements. License renewal is due by March 31st of even years
• Maryland: 30 hours per 2-year period, by March 31st on even or odd years (based on license number)
• Massachusetts: No CEU requirements. License renewal is due by the license holder’s birthday
  
• Michigan: 24 hours per 2-year period, by July 31st
  
• Minnesota: 20 hours per 2-year period, by December 31st
  
• Mississippi: 30 hours per 2-year period, by June 30th in odd years (last name A-L) or even years (last name M-Z)
  
• Missouri: 30 hours per 2-year period, by December 31st in even years
  
• Montana: 30 hours per 2-year period, by April 1st of odd years
  
• Nebraska: 20 hours per 2-year period, by November 1st of odd years
  
• Nevada: 15 hours every year, by July 31st.
  
• New Hampshire: 24 hours per 2-year period, by December 31st in even year
• New Jersey: 30 hours per 2-year period, by January 31st in odd years
  
• New Mexico: 30 hours per 2-year period, by January 31st, based on the license number (even years for a license ending in an odd number; odd years for a license ending in an even number)
  
• New York: 36 hours per 3-year period, by the last day of the license holder’s birth month
  
• North Carolina: 30 hours every 25 months, but license renewal is annual
  
• North Dakota: 25 hours per 2-year period, by January 31st
  
• Ohio: 24 hours per 2-year period, by January 31st
  
• Oklahoma: 40 hours per 2-year period, by December 31st in odd years
  
• Oregon: 24 hours per 2-year period, by March 31st in even years
  
• Pennsylvania: 30 hours per 2-year period, by December 31st in even years
  
• Rhode Island: 24 hours per 2-year period, by March 31st in even years
  
• South Carolina: 30 hours per 2-year period, by December 31st in even years
  
• South Dakota: 15 hours per 2-year period, by December 31st
  
• Tennessee: 30 hours per 2-year period, by the last day of the month before the license holder’s birthday
  
• Texas: 30 hours per 2-year period, by the last day of the license holder’s birth month
  
• Utah: 40 hours per 2-year period, by May 31st in odd years
• Vermont: 24 hours per 2-year period, by September 30th in even years
  
• Virginia: 30 hours per 2-year period, by December 31st in even years
  
• Washington: 40 hours per 2-year period, by the license holder’s birthdate
  
• West Virginia: 24 hours per 2-year period, by December 31st
  
• Wisconsin: 30 hours per 2-year period, by February 28th in odd years
  
• Wyoming: 30 hours per 2-year period, by October 1st; license renewal is due annually

This is an example of a Brookbush Institute certificate of completion with the approvals necessary to be pre-approved in 44 states, and likely to be accepted in 50 states.

Caption: Image of certificate with logos necessary for national-like approval - Static Manual Release: Cervical Muscles 1

Table 1: Mandatory for "National-like" Approval

Table 2: States with Reciprocity Guidelines

Note: We provided links to source material when there was a direct link to the relevant information. Unfortunately, most guidelines are buried behind logins, are deep inside large documents, or the information is available in pieces across various documents. In fact, much of this table was constructed from years of communicating with state chapters directly. Please do not think our failure to provide a link was because we are trying to hide information. We will do our best to keep this table up to date, and we welcome any comments below if someone has found an error, an update, or a link they think we should add to the table. The goal of this article is accuracy and ease of use!

Table 3: The Weird and the Whatever

States that do not pre-approve courses, do not require continuing education unit (CEU) submission or will accept AOTA or NATA-BOC-approved courses.

Table 4: The Bad, but Manageable

Require petition or course submission if audited.

For Additional Resources on Certification and Accreditation:

• The Best Personal Training Certification?
• How Much Does a Personal Training Certification Cost (Including Hidden Fees)?
• Building a Better Corrective Exercise Certification
• The "Real Cost" of Manual Therapy Certification
• Certification Cannot Change the Scope of Practice of a Movement Professional
• What is a Fully Accredited Personal Trainer Certification?
• What is NCCA accreditation?
• We Think About Continuing Education Credit Approval (So you don't have to)
• State-by-State Course Approval and Credit Requirements for PTs and PTAs
• Approval and Accreditation of Courses and Certifications Could Be MUCH Better!

Caption: Testimonial - I have paid for expensive manual therapy certs and not gotten half of the education Brookbush provides!!! - Chad G., DPT

© 2022 Brent Brookbush (B2C Fitness, LLC d.b.a. Brookbush Institute )

Comments, critiques, and questions are welcome!