Choosing to Specialize in Physical Therapy

Sonya L. Irons, PT, DPT, CCS
Posted 10/12/23

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When I get asked about my pathway to a board certification in cardiovascular and pulmonary physical therapy (CCS), it provides an opportunity for reflection. The CCS specialist is the fourth smallest physical therapist specialist group with just 507 specialists across the United States, compared to 21,401 board certified orthopaedic specialists as of June 2023.

Pathway to CCS

I didn’t necessarily plan to take a specialty examination upon graduation. However, my pathway to CCS felt like a natural progression during my first clinical job after graduation. I had a full-time position, split across two hospitals—50% of my position assigned to acute care at a heart hospital and 50% assigned to inpatient rehabilitation as a float position. The inpatient rehabilitation hospital had a robust cardiac program and medically complex patients, so I was seeing patients with cardiovascular and pulmonary diagnoses at both locations. 

Since I worked at a facility that employed many orthopaedic, neurologic, and geriatric specialists, I quickly learned more about becoming a clinical specialist. One day a colleague asked me, “Will you apply for the cardiovascular and pulmonary specialist exam?” That was the prompt I needed to start the process. I learned that there are lots of certifications available for physical therapists, but there are only 10 that are sanctioned by the American Board of Physical Therapy Specialties (ABPTS). I was passionate about working with patients with cardiovascular and pulmonary conditions. My case load included patients with congestive heart failure, chronic obstructive pulmonary disease, lung cancer, and myocardial infarction, to name a few of these diagnoses and conditions. I also worked with patients after surgery, such as coronary artery bypass graft surgery, pacemaker, or left ventricular assistive device. When I studied the requirements, it seemed like a great fit given my high number of concentrated hours working with this patient population.

Specialty Exam

To qualify to sit for any of the specialty examinations, ABPTS requires 2000 hours of direct patient care in the specialty area as a licensed physical therapist in the United States within the last 10 years, with 500 of those hours occurring in the last three years. From there, each of the specialty sections may have additional requirements. For cardiovascular and pulmonary physical therapy, this meant I needed to also submit proof of Advanced Cardiac Life Support certification and submission of one data analysis project or case report. Once I determined I met all the criteria, I filled out the application by the deadline, paid the associated fees, waited for approval to take the test, signed up for the test at a testing center, studied for the exam and ultimately took the rigorous eight-hour exam.

There are 10 different options for specialization through ABPTS including: cardiovascular and pulmonary, clinical electrophysiology, geriatrics, neurology, oncology, orthopaedic, pediatrics, sports, women’s health, and wound management. Sometimes, clinicians will pursue two specializations. For example, I have colleagues that are dual certified in sports and orthopaedic or dual certified in geriatric and neurology. However, one cannot use the same patient care hours to apply for multiple specialty applications. Requirements can vary between the specialty examinations, so it is best to review the latest and greatest posted by the ABPTS.

The pathway and reasons for pursuing certification varies for each person, but pursuing specialization certification demonstrates competency in a specialized knowledge area and advanced clinical proficiency. It is something you pursue after some time working in the field, as it is not a requirement to practice as a physical therapist. Students in physical therapy school may decide that they want to attend a residency immediately after graduation, which fast tracks the clinician to a specialization exam. In those cases, the residencies are providing the concentration of hours for a specific patient population along with structured mentoring. In other cases, pursuit of a specialty certification may be a requirement for a job, such as an orthopaedic clinical position requiring sports and/or orthopaedic specialization within a certain time frame from hire. Some faculty positions require a clinical specialization in addition to having a clinical doctorate degree. Other clinicians have pursued specialization to increase the breadth and depth of their knowledge in a specialty area to better serve their patients.


Upon passing my CCS exam, I attended a ceremony for new clinical specialists at the Combined Sections Meeting of the American Physical Therapy Association. This allowed for a fantastic networking opportunity to meet with other clinical specialists from across the country. 

Eventually 10 years passed in my career, and I submitted a renewal application (and fees) to renew my certification. Initial certification lasts for 10 years, and so does each subsequent re-certification period. Now I am in what is called Maintenance of Specialization Certification (MOSC). For MOSC, this means that I submit a professional portfolio every 3 years (with a fee) including a case report reflecting a current patient, aiming to achieve a certain number of points in a certain number of categories, while including proof of 200 practice hours in the specialty area. If I successfully achieve all 3 periods of MOSC requirements over 10 years, then I will need to take another examination to continue the recertification process.

Looking Back

It is an investment of time, money, and energy to pursue a specialization. You might be asking yourself, “Is it worth it to pursue a specialty certification?” To answer this question, it requires reflection on your interests, passions, and career goals. Receiving a board certification opened so many doors for me including opportunities for teaching, mentoring, and research. Would those doors have opened otherwise? I am not sure. From a financial standpoint, the American Physical Therapy Association reports that board-certified physical therapists earn higher incomes than non-certified physical therapists.

About the author: Sonya L. Irons, PT, DPT, CCS is a Board Certified Cardiovascular and Pulmonary Clinical Specialist and a course instructor for Scorebuilders.