COLORADO PHYSICAL THERAPY LICENSURE
Policies of the Director, Division of Registrations
Colorado Dept. of Regulatory Agencies

Director’s Policy on Supervision of Physical Therapy Students.
Adopted July 28, 2003.

This policy addresses whether a physical therapy student counts as one of the three unlicensed individuals that a physical therapist may utilize to assist in that therapist’s practice.  The Physical Therapy Practice Act (“the Act”) at section 12-41-114(1)(a) permits the unlicensed practice of physical therapy by students enrolled in an accredited physical therapy program if performed under the direction and immediate supervision by physical therapists currently licensed in Colorado. In section 12-41-113(1), the Act states that a "physical therapist may utilize the services of not more than three unlicensed individuals to assist in that therapist's practice. However, the Act does not specifically address whether a physical therapy student should be excluded as one of the three unlicensed individuals.

The Act clearly states that a licensed physical therapist cannot utilize the services of more than three unlicensed individuals.  A physical therapy student is not licensed; thus, the reason an exclusion from licensure was created for students in section 12-41-114(1)(a), C.R.S.  The exclusion requires the student to perform “under the direction and immediate supervision of a physical therapist. . . .”  This is a higher level of supervision that is required for a physical therapy assistant, which practices under “responsible direction and supervision of the physical therapist.”  The supervision required for students is similar to other unlicensed individuals commonly referred to as physical therapy aides, which practice under the “direct supervision” of the physical therapist.  The Act at section 12-41-113(1), C.R.S., defines “direct supervision” that is on the premises where any such unlicensed individuals are practicing.  Although the supervision levels are significantly different between assistant and aides, the Act limits the number of supportive personnel to three regardless of the unlicensed individuals credentials.

The Director believes that in the interest of public protection, a physical therapist should not supervise more than three unlicensed individuals regardless of the unlicensed person’s credentials.  The Director acknowledges that clinical internships by physical therapy students are an important part of their education necessary to become licensed as physical therapists in Colorado.  As such, the Director is willing not to apply the supervision restriction when physical therapy students are only observing the practice and not engaging in patient contact.  However, once a physical therapy student begins to assist in the practice of physical therapy as defined in 12-41-103(6), C.R.S., the physical therapy student counts as one of three unlicensed individuals.

Adopted July 28, 2003.

June 11, 2003

Mr. Kevin D. Heupel
Program Director
Physical Therapy Licensure
Division of Registrations
Dept. of Regulatory Agencies
1560 Broadway #880
Denver, CO 80202           

RE: PT/PTA Student Supervision

Dear Kevin:

I am writing to inform you of the reasons that the APTA/Colorado Chapter is strongly opposed to changing the long-standing interpretation that has exempted PT and PTA students from the number of unlicensed individuals whom a Colorado licensed Physical Therapist can supervise. I have talked to numerous long-time practicing PTs in this state and none can remember a time when students were included in the total.

Prior to 1991, the PT Practice Act only allowed two unlicensed persons to be supervised by a PT. During our Sunset Review that year, the Hospital Association argued for a higher number (4 or 5); The APTA compromised to the current number of three as being an appropriate number and one that would not adversely affect patient care. The number three was never meant to include students.

As I have discussed with you, grafting this interpretation on the Physical Therapy Practice Act would be a major change. It would devastate physical therapy education in Colorado, because very few, if any, Physical Therapists who serve as Clinical Educators would be willing to relinquish one or more of their unlicensed person slots to train a student. Clinical Educators need to utilize the three unlicensed persons to assist them in their practice WHILE they are working hands on with their student on physical therapy techniques and procedures. 

Further, we oppose counting students as one of the three unlicensed persons because:

1.   The relevant parts of the Physical Therapy Practice Act, CRS Sections 12-41-113(1) and 12-41-114(1)(a) [prior to 1991, CRS Sections 12-41-123 (a) and (g) ] have been essentially unchanged since at least 1982 and no such interpretation has ever been raised previously. The 2001 Sunset Bill, as enacted, was essentially a “strike below” on this issue, so no contrary “legislative intent” should be gleaned from the 2001 actions.

2.   The three unlicensed person limit contained in CRS Section 12-41-113(1) refers to “…individuals [to] assist in that therapist’s practice…”.  It is widely understood that the students are not there to “assist” the therapist’s practice; they are there to further their education by gaining valuable clinical training, consistent with CRS Section 12-14-114-(1).

3.      There are parallel provisions in the Medical Practice Act which restrict physicians to using no more that two PAs in their practice. CRS 12-36-106(5)(b)(I), also includes an exemption from that Act for medical students in CRS 12-36-106(1)(k) and we find nothing in that Act or in the BME Rules and Regulations interpreting that Act declaring that such medical students should be counted as PAs or included in the general provision allowing physician extenders (no limit on number) contained in CRS Section 12-36-106(1)(l).

In summary, we believe that in physical therapy, as in medicine, hands-on training opportunities in private practices and other practice settings are critical to the proper education of these health care professionals. The public policy of Colorado should be to encourage and not hamper such opportunities.

We urge you to exempt PT and PTA students from the supervision limit and we request an opportunity to speak before the PT Advisory Committee when it next meets on July 16th.

Sincerely yours,
Ellen Caruso
Executive Director

Cc:  APTA Executive Committee