This is one of those stories that has everything: action, intrigue and a surprise ending.

The action is the race to get credentialed as a Workers' Compensation practitioner by taking a new exam put out by the International Sports Professionals Association (ISPA). Wait a minute - sports? That's right. And that's where the intrigue comes in, because this test makes athletic trainers eligible for the same credentialing as OTs and PTs in WC practice. More about that farther down.

Meanwhile, the surprise ending is that, at least initially, occupational therapists seem to be passing the exam better than physical therapists. "OTs have been doing fairly well across the board," Andrew Teunis, director of business development for ISPA, told ADVANCE last week. "We've had a lot of PTs fail the exam. That really surprised us."

The Workers Compensation Rehabilitation Certification Standards for Healthcare Providers (CWcHP) exam hit the market in June. So far, about 200 people have taken the exam, Teunis said. The test includes knowledge of legal rights and employer costs and issues as well as clinical and practical rehabilitation best-practice principles that are evidence-based.

It also adds elements of patient/client management, transitional work and employee education that ADVANCE thought might be giving OTs a leg up because of their psychosocial training. But Chris Stout, PsyD, of ATI Physical Therapy in Chicago, who helped facilitate the test construction, said that the exam developers had made no special effort to include mental health aspects.

"Our items were derived from content experts from the Comp field who were varied in terms of background insurance, exercise physiology, physical therapy, athletic training). All of them shared a common denominator of many years working with comp clients," he said.

Though the credential belongs to ISPA, it was not originally ISPA's idea.

"There is no existing standard across the board for health care providers [in Workers' Comp)," Teunis said. "ATI and PRO in Delaware came to us with the idea of building a standardized exam."

Why a sports association? Because PTs in back-to-work and personal training programs have been treating people who, for all accounts and purposes, need to be as fit as athletes to perform their duties. Nicknamed "industrial athletes," these people include firefighters, police and military personnel, among others. Athletic trainers are involved in this work.

ATCs are regulated in 47 states, according to the National Athletic Trainers Association (NATA), but their road to licensure has been rocky. In some states, ATC associations tried to copy OT or PT licensure laws already on the books to make the process easier, claiming that trainers did basically the same thing as these professionals. Most of the time they were stopped and ended up having to draft their own bills. But the squabbles left a bitter taste in the mouths of PTs and OTs, who scorned the term "industrial athlete."

Teunis said he has received calls from OTs and PTs who are angry about the new certification.

"I've had to calm them down a little bit," he told ADVANCE, admitting that it would "not be fair" to claim that ATCs were equal to the rehab professionals in education.

 ATCs take four-year programs that grant them a BS in athletic training. The programs are heavy on anatomy/physiology side but do include some psychosocial coursework. In order to work, athletic trainers must pass the certification examination given by the Board of Certification. And they must take continuing education to keep their certification. NATA claims that more than 70 percent of its members have advanced-level degrees, and its current research shows that ATCs have had better outcomes in rehab than their counterparts, in particular studies

Still, in some states ATCs cannot work in rehab by law. In others, they work under physical therapists. 

"We're not looking to start a war here," Teunis said. "We aren't licensing people to work - not creating some kind of loophole. [ATCs] still need to abide by their state statutes. But we feel confident that by passing this exam, a qualifying individual is shown to have the level of knowledge necessary to be involved in rehab."  

The elephant in the industrial rehab clinic is money. Teunis added that, "by creating this certification, we've kind of opened up this whole new thing with third-party payers." ISPA is actively courting private insurers to back its new credential. If they do, it could mean problems for OTs and PTs, whose pay can be almost double what an ATC makes. Bureau of Labor statistics from 2008 say that ATCs were making an average of just under $40,000 a year. But on the higher end, their salaries reached into the sixties.

Their numbers are still few in comparison to OTs and PTs. ATCs held some 16,300 jobs across the country in 2008. But 38 percent of them worked in health care, and the industry is expected to increase by 37 percent by 2018.

 The fail rate for the new exam has been about 14 percent. The average passing score is 79, four points above the 75 percent needed to certify.

ATI currently has a survey out for Workers' Compensation professionals asking for their feedback about their practice. Occupational therapy, however, is not included as one of the identified participants.

ADVANCE asked Stout about that fact, and he basically apologized, saying it was "an oversight. I am now taking steps to edit the survey and repost an improved version."

So shortly, OTs in Workers' Comp practice who go to www.atipt.com will be able to post under their own profession rather than under "other."