Clinical Instructors and Faculty Supervising PT Students Across State Lines

Physical therapy education crosses state lines constantly. A program in one state places students in clinics across a region. A faculty member supervises a pro bono clinic across the river. A clinical instructor at a hospital near a border takes students from three schools. In each arrangement, the patient's location decides which state's practice act applies, and the licensed clinician responsible for the student's care has to be authorized in that state.

Supervisors carry the credential

Students provide care under the supervision of licensed clinicians, and what a student may do is set by the practice act of the state where the patient is. The supervising clinician's authority is not borrowed from the program. A faculty member licensed in the school's state who supervises students treating patients in another state needs a license or compact privilege in that state, the same as anyone else treating there.

For clinical instructors employed by the facility, this usually takes care of itself, since they are licensed where they work. The gaps appear with academic faculty who travel to sites, supervise in faculty practices or pro bono clinics outside the home state, or step in when a site's instructor is out.

Check the student rules in each state

Practice acts differ on what a student may do, what level of supervision is required, and how PTA students are supervised. Some address students directly; others speak only to supervision in general. A director of clinical education placing students in several states should know the rules at each site, and a faculty member supervising in person should read the host state's act before the first day. Where the text is unclear, the state board is the source.

Telehealth and remote supervision

Programs increasingly use telehealth for patient care experiences and for virtual check-ins with sites. When a student treats a patient by telehealth, the patient's physical location governs, and the supervising clinician needs authority in that state. Observing a student remotely during a site visit is a different activity from supervising care. If the observation turns into directing treatment, treat it as practice.

Where the compact helps faculty

Faculty whose home state is an actively issuing member can obtain privileges in the other issuing states where they supervise, subject to the usual eligibility rules and any jurisprudence exam. For sites in states outside the compact, including California, Florida and New York, or in Maine, Michigan and Rhode Island until they begin issuing, a license by endorsement is required. Programs placing students in those states should plan for it early, because faculty supervising there cannot rely on a privilege.

Clinical affiliation agreements often state which party verifies instructor credentials. Read that clause and make sure someone actually does the checking, for every site and every term.