Recognizing the need to protect and advance the profession, APTA leadership began to push more strongly for state practice acts that would regulate the use of relevant occupational titles such as physical therapy and control the right to practice within those regulated professions in the name of protecting the public from unskilled caregivers. Although state licensure could and did evolve through a variety of mechanisms, it was generally up to interests within each state to initiate the process through application to the governor or legislature. Licensing in Pennsylvania and New York had developed through this process decades earlier, Pennsylvania in 1913 and New York in 1926, and Mildred Elson, APTA’s first executive director, had challenged APTA chapters in the other states to get the ball rolling in their separate jurisdictions.
In the meantime, APTA took the initiative to develop an objective test that would evaluate individual competency. The test would give states an alternative to developing and grading their own tests, which might encourage them to seek regulation; and it would establish a nationwide standard of competency independent from diverse state licensing practices. The result, in 1954, was a seven-hour multiple-choice examination with 310 questions spread over the basic sciences, clinical sciences, and theory and procedures. Florida was the first state to avail itself of the APTA-PES exam, and 11 others had followed suit by 1958, with many more to come.