Background

According to the House of Delegates policy Clinical Specialization in Physical Therapy (HOD P06-19-66-30), “Specialization is the process by which a physical therapist builds on a broad base of professional education and practice to develop greater depth of knowledge and skills related to a particular area of practice. Clinical specialization in physical therapy responds to a specific area of patient need and requires knowledge, skill, and experience that exceeds entry-level physical therapist practice and is unique to the specialized area of practice.” Within this model of clinical specialization, a candidate should demonstrate these three overlapping elements —  knowledge, experience, and skill —prior to certification. Below is a description of each element and the current assessment or requirement used to measure it.

Knowledge

Knowledge can be defined as information and skills acquired by an individual through experience or education. The Description of Specialty Practice for Orthopaedic Physical Therapy clearly defines the knowledge base of a practicing orthopaedic clinical specialist. It includes an understanding of both the clinical application and the science underlying this knowledge base. “Knowledge” is defined in the DSP as the components or areas of physical therapist practice utilized by orthopaedic clinical specialists.

These knowledge areas include:

• Human anatomy.
• Movement science.
• Pathology/pathophysiology.
• Pain science.
• Medical and surgical considerations.
• Orthopaedic physical therapy theory and practice.
• Critical inquiry for evidence-based practice.

Currently, a candidate’s knowledge in the area of orthopaedics is measured by the successful completion of the orthopaedic specialty examination.

Experience

Experience can be defined as knowledge or skill acquired over time. While the number of hours of care required for a physical therapist to be considered a specialist can be debated, for the past 2,000 hours of direct patient care in the area of specialization has been the measure of clinical experience for the past 20 years. This number is consistent across clinical specialty areas.

Skill

Skill can be defined as the ability to do something well. The DSP states that advanced specialty practice in orthopaedic physical therapy requires specific skills.

These skills include:

• Patient and client examination, including performance of tests and measures.
• Evaluation.
• Diagnosis.
• Prognosis.
• Intervention.
• Outcomes.
• Professional roles, responsibilities, and values.

Currently, a candidate’s skill in orthopaedic physical therapy is measured by the successful completion of the orthopaedic specialty examination.

Breadth of Knowledge, Experience, and Skill

The DSP also clearly defines major areas of competency across a breadth of anatomical regions.

These areas of competency include:

• Head/maxillofacial/craniofacial.
• Cervical spine.
• Thoracic spine/ribs.
• Pelvis/sacroiliac/coccyx.
• Shoulder/shoulder girdle.
• Arm/elbow.
• Wrist/hand.
• Hip.
• Thigh/knee.
• Leg/ankle/foot.

Breadth of knowledge, experience, and skill are not assessed in the current model.

Purpose

The purpose of this document is to describe modifications to the current minimum eligibility requirements. Specialization requires knowledge, experience, and skill across a breadth of topics and anatomical regions. While the current model assesses the three major components of clinical specialization (knowledge, experience, and skill), an applicant is not evaluated on these components across the breadth of regions specified in the DSP. The following model serves to address this shortcoming.

Precedence

There is precedent for setting additional eligibility requirements beyond the minimum values established by ABPTS (Table 1). Cardiovascular and pulmonary applicants must be currently certified in advanced cardiac life support and submit evidence of participation in research. Clinical electrophysiologic applicants must submit evidence of clinical education and provide patient case reports. Sports applicants must show current certification in cardiopulmonary resuscitation and in emergency care. They must also demonstrate at least 100 direct patient care hours in an athletic venue. The changes for the orthopaedic applicant follow the precedent set by other councils.

Table 1. Comparison of Minimum Eligibility Requirements Across Areas of Specialization

Additional Rationale for Change

It can be argued that the requirements for recertification are more stringent than the requirements for initial certification (Table 2). Applicants for re-credentialing as orthopaedic clinical specialists now must demonstrate maintenance of competency in the specialty through the Maintenance of Specialist Certification, or MOSC, program which include the following elements:

• Professional standing and direct patient care hours.
• Commitment to life-long learning through professional development.
• Practice performance through examples of patient care and clinical reasoning (clinical case portfolio).
• Cognitive expertise through a test of knowledge in the profession.

Of these requirements, commitment to professional development and clinical reasoning case examples are not required of the candidate for initial certification. This may create a perception among current orthopaedic clinical specialists that there is inconsistency between the two processes. In the view of the Orthopaedic Specialty Council, this is a valid concern. The changes are to help address these concerns by better aligning the initial certification requirements with the new MOSC process and requirements.

Table 2. Current Initial and Recertification Requirements

New Requirements for Initial Orthopaedic Specialty Certification as of 2026 Exam Administration

The Orthopaedic Specialty Council has instituted the following minimum eligibility requirements to sit for the initial orthopaedic specialist certification examination. Table 3 outlines the changes from current requirements, which are summarized here:

• 2,000 direct patient care hours subdivided into body region groupings.
• The requirement for evidence and approval of regional direct patient care hours modified.
• Direct contact hours may be replaced by observational or mentored hours under the direct supervision of a certified orthopaedic clinical specialist.

Table 3. Comparison of Current and New Initial Certification Requirements

Option A:

Applicants must meet the following requirements:

• Requirement 1: Professional standing and direct patient care hours to include patient experiences involving the regions and components identified in the DSP:
  • Submit evidence of current licensure as a PT.
  • Submit evidence of 2,000 hours of direct patient care in the specialty area within the last 10 years; 300 of which must have occurred within the last three years. (Refer to the document titled “What Activities Constitute Direct Patient Care.”)
  • These 2,000 hours of direct patient care hours in the specialty area will be further subdivided into regional requirements. Candidates shall submit evidence of patient contact as listed below in Table 4.
  • Direct contact hours may be replaced by observational or mentored hours under the direct supervision of a certified orthopaedic clinical specialist.
• For the arm/elbow and wrist/hand regions, candidates may observe or be mentored by a certified hand therapist.
• This is a direct and equivalent substitution. One hour of observation or mentoring equals one hour of direct patient contact.
• All hours require verification by the supervising clinical specialist or hand therapist.

Table 4. Clinical Hours Needed per Region of the Body

• Requirement 2: Cognitive expertise through a test of knowledge in the profession.
  • After verification of completion of Requirement 1 and fees paid, applicant is eligible to sit for the examination.

Option B

Applicants must submit evidence of successful completion of an APTA-accredited post-professional clinical residency in their respective specialty. Applicants who are currently enrolled in an APTA-accredited clinical residencies (or are enrolled in a residency program that has submitted an accreditation application to ABPTRFE no later than March 1) may apply for the specialist certification examination in the appropriate specialty area prior to completion of the clinical residency. These applicants will be conditionally approved to sit for the APTA Specialist Certification Program examination, as long as they meet all other eligibility requirements, pending submission of evidence of successful completion of the APTA-accredited clinical residency.