Professional- licensure, reimbursement, other

Hi All,
Beyond a job position of senior clinical exercise physiologist, what can one expect to be a reasonable job progression? What experiences have any of you had in your current place of employment that may be beneficial for career progression titles/positions and job descriptions for institutions new to hiring clinical exercise physiologists?
Thanks!

Hi Carol,
As I'm sure you're aware, different institutions have differing approaches to promotion of clinical exercise physiologists. As you mention, senior (or lead) CEP is a fairly common position. Many institutions have CEPs as the "coordinator" or "supervisor" of a cardiac rehab program or cardiac testing unit. In addition, those with advanced degrees often have the opportunity to work in middle management as managers of cardiac rehab, cardiac testing, heart failure clinics, etc. For staff who are "working their way up the ladder", it's a good idea to consider how they might contribute in a different way (teach about exercise in a diabetes clinic, work as a consultant in a weight management program, become the staff "expert" in a particular area of chronic disease and exercise). When CEPs engage in these ways and become involved with other healthcare professionals, we help promote the work of clinical exercise physiologists and help to grow our profession.

CEPs, to create job growth at my organization my leadership has suggested finding job descriptions at other centers that have a "tier" approach to compare to. Would anyone be willing to share their organizations job descriptions or what job titles are offered at their organization? For example, Exercise physiologist vs, clinical exercise physiologist vs stress lab manager, or cardiac rehab manager. For example, you can find at centers sonographer level 1, sonographer level 2, sonographer level 3, and lead sonographer.

Hello Kate,

Thanks for reaching out regarding these questions. A great place to start would be reading through the CEPA White Paper on compensation strategies (located in the "Advocacy" tab on CEPA's website), which includes recommendations regarding alignment of position titles, job description review, and implementation of career ladders.

Thank you so much for highlighting this information. I am using it as a guideline to revise my salary and job description at my current position in a hospital environment, so very timely.

I have some resources that you may find helpful. Feel free to reach out to me via email after reviewing the document Garett referenced above matthew.thomas525@commonspirit.org

I've been having struggles for a long while now at the hospital I work at. Management seems to be of the opinion only nurses can do certain tasks or hold certain positions. It took years of pleading to get them to allow us EPs to do initial patient evals and they still won't let us run the phase 3 program unless an RN is there, which is crazy. And they definitely won't let us hold a supervisor position, as this has recently come up and it's for RNs only. How many of you work in programs with EP led phase 2 and/or phase 3, EPs who do evals, or EPs who are program managers/supervisors? I've been an EP for 19 years and have my MS and CEP, so this is really frustrating.

Hi Jason. I live in NJ and have had very similar struggles. I was considered under the RNs for “supervision.” Extremely frustrating when I was in cardiac rehab given that RNs are not usually trained in exercise and exercise progression. This seems to be a huge hurdle for our profession, perhaps in some States more than others.

Hi Jason,

I have been part-time at my hospital for almost 30 years in cardiopulmonary rehab. In that time, I have been the only steady exercise physiologist in a team of RNs, RRTs, and recently PTAs and PTs. I have always been told that am 'not allowed' do do evals because I don't have a license. I never really pressed it. I was always happy with the duties that I had: stress testing, managing the employee fitness program, handling the exercise prescriptions, etc.

Over the years, I have developed a variety of patient and staff programs, e.g. the remote rehab program during covid, the SET for PAD program, etc. I have also taken over some of the CQI, inservice planning and tracking, and patient education development duties. These things are far more engaging to me than doing evals--a job I would take on happily, but only if I was asked. I am a CDCES so the patients so I often manage the patients with diabetes when there's a question re: care.

As far as running a P3 program, in my early years I was often the only staff member to supervise P3 patients. In recent years, our patients have more cognitive decline and more physical limitations so I've requested to have two staff memeber on at all times. And we do.

As far as a supervisor position, the manager of our program for the last 20 years is an NP. The person under the manage is a full-time nurse. The rest of our staff are part-time. Because of the requirement to always have an RN on the clock when there are P2 patients, that makes sense to me.

Good luck. My struggle is to get admission into the hospital's union. Now there's an issue that has really sucked the life out of me.

Peggy Kraus, CEP, CDCES

Cardiopulmonary Rehab

Stony Brook Southampton Hospital

240 Meeting House Lane

Southampton, NY 11968

631-726-8620 office

I'd be happy if they just let us run the phase 3 program without an RN, which seems more than reasonable. There is nothing an RN would do in an emergency that an EP couldn't do, protocol is BLS and 911. Plus RNs cost way more and they are always stressing money and productivity. They say the covering MD and Risk Management want an RN there, but for what? What is the increased risk of having an EP instead of an RN there? They can't answer that.

Jason Butler MS, ACSM RCEP

John Muir Health

925-586-6706

Wow, Jason. This sounds super frustrating. I understand your struggle. I have much struggle often daily with my management who is not a CEP or RN or RT and has no Cardiac Rehab experience. Her background is radiology and was handed Cardiac Rehab to manage. I am a Supervisor and have a Masters in Exercise Physiology and have had my RCEP for 19 years. I supervise 8 staff, 3 being RNs and 2RTs, 2CEPs and one admin. Every clinician regardless of discipline is responsible for all aspects of the job, ie patient evaluations, intakes, discharges, education, documentation, supervision, etc. That includes Cardiac Phase I, II and III, SET PAD, Pulmonary and EECP. We have staff that are CEPs opening and closing without an RN or RT present. As far as supervision for Phase 3, that's just honestly a control thing. A phase 3 program is technically just a supervised fitness program, or wellness center. Fitness programs and wellness center are managed and run for CEPs. I've started 3 different phase 3 programs at 3 different hospitals over my career. There is nothing in writing with ACSM or AACVPR which states anything about an RN having to always supervise a Phase 3 program or even a Phase 2 program for that matter. I would find some research articles and provide proof if its something you want to bring forward. Also look on the AACVPR dashboard. There are many topics around this issue that are posted often. Of all days today I totally understand your frustration. We have a CRP who was recently engaged and I know he plans on moving once he's married. He has not turned in his resignation but its coming in the next few months. With that in mind, I discussed this with my manager today. I talked about opening up a position before he leaves. Her response was that she was not planning on opening up a CEP position but rather an RN position. We already have 3 RNs. I tried to explain the difference and how its much easier to train a new EP grad on clinical protocols versus train an RN with no Cardiac Rehab experience on Exercise Prescription. The response I get..."how hard can ExRx be? Are you saying an RN isn't capable of learning that?" So the response I receive is from someone who doesn't understand the importance of ExRx and how we tailor programs specifically to patients for outcomes and how we take years of schooling just for ExRx. It's frustrating. I brought up that I have a CEP who would be intereated in this position at a neighboring hospital who has 25 years experience, working toward his master's, is a CSCS, ACSM-CEP and CCRP certified. But she wasn't interested. She'd rather get an RN who has never worked in Cardiac Rehab and then I have to train them. I have 2 like that now who have been with us a year and Im still training them. So while in some cases we are farther along by allowing CEPs to supervise, we still have many other things to overcome.

I know your struggle, Jason. Many great CEPs have been in the boat you're in. It seems that CEP job duties & opportunities can vary highly between employers/hospitals. Matt Thomas provided a great webinar on discussing some of these issues (especially when it comes to compensation) in a CEPA webinar a few years ago. I've been very fortunate to land a supervisor role at my institution last year. Previously this was held exclusively by RNs for almost 40 years. Things have changed dramatically for all of the CEPs within our health system recently. We have 3 cardiac rehab sites, each site has a supervisor CEP that oversees the daily workflow with a CEP manager overseeing all 3 programs. I've been in the field for 9 years and I've never seen our programs flourish like they are now. Each site has broken record volumes over the past 2 years when the changes started taking place. Workflows and staffing are also more dialed-in than ever. We recently had a day, at my site, where we had 4 CEPs as our entire staffing for the day. I thought I'd never see this happen; it was a beautiful sight to behold.

The big catalyst for us was the previous manager (who was an RN) moved up the ladder within our organization and believed in & advocated for CEPs and what we could do. He hired a great CEP to replace him and things began to really change for the better for CEPs within our health system.

Higher-ups (managers, directors, physicians, etc.) have to advocate for you within your institution. This provides you with leadership opportunities to drive the change that you want to see. It took our specific program almost 40 years to achieve this. I hope you can get there too. I'm also thankful for the advocacy that CEPA is providing, and forums like this that we can vent our frustrations on! ;)

Wyatt Nicholson, MS, ACSM-CEP

Supervisor - NGMC Habersham

706-754-3113 ext 22455

This all sounds so familiar-- I have been in the field for 40 years so have definitely seeen the progression of our programs, roles and responsibilities. It saddens me that as EPs we are still relegated to support positions when, in reality, we are the ones who actually receive training and education specific to the field of cardiopulm rehab and so are the ones who impart this knowledge to RNs, RRTs and other health professionals. I am fortunate to have been in a supervisory position for the last 30 years with support to advocate for my staff and grow my programs with my perspective as an EP, but am still fighting the compensation battle in my healthcare system where those other professions make sometimes double what the EPs do-- for doing the exact same job. It is not right and we need to continue advocacy efforts towards licensure and acceptance for our unique roles.