Physical therapy is at a crossroads. Providers are seeing too many patients. You’ve heard that before, everyone complains of it, and it’s pushing people out of the profession. Overworked and underpaid therapists are on every corner. In every strip mall, hospital basement, and senior living home. What can be done about it? And how can we change for the good?
Supply
The supply of physical therapists isn’t want this section is about. It’s about the supply of patients. Baby boomers are aging, Gen X is starting to get to retirement age, and Millenials are getting into their 40s. Musculoskeletally, 40 is the age when arthritis isn’t entirely unexpected, and soft tissue wear and tear goes from an issue that needs immediate attention to one that becomes an option “if you want to go that route.” The amount of people fitting the definition of “do I have pain or am I limited functionally” has never been higher.
Ask anyone in physical therapy, and this is an opportunity. People needs us, we are important! Well, let’s dig a little deeper. Physical therapists have a license that is at the absolute top of the rehab world. Instead of having a profession that specializes in one part of rehab, we can do it all. We can massage, manipulate the spine, use acupuncture needles, and get someone moving. We are a massage therapist, chiropractor, acupuncturist, and personal trainer all in one!
The issue we have is we want it all. When we can do it all, then anyone in non-visceral pain is our patient. We could never hope to meet that need.
Turf War
How many times have you seen a personal trainer advertising how they helped people out of pain, or a chiropractor with a TRX and weight rack in their office? What about the massage therapist that has a different approach because they use movement to address soft tissue problems? How dare they! They are’t trained like we are!
Well, the dirty little secret is that they are. How much of the typical outpatient orthopedic caseload could be helped if someone just paid the tab for a small-group fitness class? In some of my previous gigs, I’d put that number at about 50%. Half of my volume struggles was because I was the only provider of exercise motivation their insurance covered. This is awesome, and many people benefitted, but is that the best use of the tiny talent pool of available PTs?
I think this is where the majority of the frustration is coming from. Insurance companies are getting similar results from mills as they are from clinics that keep a reasonable number of patient visits. The insurers see absolutely no financial reason to raise rates because a lot of patients just need accountability for a more active daily routine. This frustrates PTs because the other 50% of people who truly have an acute injury, or have significant comorbidities requiring skilled care are given the same amount of time. When you see someone who truly needs care not receive it, burnout ensues.
PTs As A Problem Solver
I think physical therapy has started a race to the bottom, and squandered our position as the most evidence-based rehab profession. We had the preferred seat and pushed to see every patient, assuming reimbursement would go up at least to match inflation. Well, funny story, it didn’t. We became personal trainers and massage therapists to half of our caseload, burned ourselves out, and chased quantity over quality.
The solution here is to re-imburse for personal training, massage, acupuncture, and chiropractic (gasp!). Hear me out .. it will allow the few PTs practicing to truly be the problem solver. They will be the backup when the placebo treatments and motivation treatments don’t work. The amount of Americans seeing surgeons is no-where close to those seeing PTs, but because their value is so high, they make a pretty decent living. If we could juice the value of PT by legitimately saving more people from surgery, preventing falls, and changing the predicted course of care based on initial diagnosis, I believe we could command more reimbursement.
The Future
I think the physical therapy profession is finding our way, as more and more people get access to good evidence. Personal trainers are now learning safe and effective stretches and exercises. Chiropractors are incorporating exercises in every treatment session because the results are superior. Massage therapists are teaching people how to move instead of just laying there and getting poked and prodded. These are all great things for the population at large because people who used to spend money on sham treatments because they were told it’s great can now work within those biases and actually get better.
For physical therapists however, this presents an existential problem. Those that fill their clinics with people who just need to work out more, or who can’t afford massage therapy are going to see a drop in volume. If their skills and offerings to the patients can’t solve their problem over “here’s a sheet, do the exercises,” they are on borrowed time. This is good for the profession because it will force people to get better training to keep up, or find another profession.
