Physical Therapy News – Physical Therapy Education Solutions

Telehealth and Physical Therapy: A Good Fit?

Jon Waxham, PT — Wed, 01 Dec 2021 22:08:04 +0000

There has been a gentle fascination regarding the use of telehealth for physical therapy services for the last few years. This change was accelerated and necessary for survival with the onset of the COVID-19 pandemic. I understand that the ability to see patients remotely helped to keep many outpatient practices above water, or at least able to tread water until things transitioned back to a semi-normal routine. Since then there has been this giant push to make telehealth a permanent part of physical therapy practice, but has anyone stopped to ask if this is good for our profession in the long run?

During my interview for PT school I was asked, is physical therapy science, or art? Of course my answer was some of both. The technical part of the job is science based, but the ability to interact with patients through words, body language and palpation has that touchy, feely, artful component. Dave Nicholls with the Critical Physiotherapy Network wrote a blog pondering this same question, is physiotherapy a technical craft or an art practice? He noted that “With technical craft skill being one of the central locations for innovations in new technology, it is likely that many of the old skills of the physiotherapists will be picked up either by people who are much less expensive to train than us, or machines” (1). If that is the case, what is left for the PT to do?

If we decide that we can function without being physically present with our patients, we give up the “art” component of our profession. Then it is only a matter of time before we will become obsolete. Some will argue that we are experts in movement and patients need that expertise. Well here’s some bad news, there are artificial intelligence programs that can analyze movement just as well as we can, or better, and make recommendations for activity modification, corrective exercises, and pain management strategies.

With the use of hi-def video and wearable sensors, patients can collect their own data and use AI to get recommendations and feedback on performance and progress. All of this technology exists currently and is becoming increasingly available to the public. Why pay us to watch and analyze their movement and correct their exercise when a computer can do the same thing for free and at their convenience.

Michael Rowe from the Department of Physiotherapy at University of the Western Cape opined on the impact of AI on physical therapy clinical practice and made this point, “if the nature of future practice is such that the technical components of the discipline (PT) are outsourced to intelligent machines, we may find ourselves in the position of being well-trained, competent, and irrelevant.” (2)

There is no doubt regarding the benefit of physical contact in patient care, but we seem to be blindly jumping into a system of providing care that robs the patient of that component of physical therapy. One of the things I love about being a PT is that I have developed manual skills over a 23-year career that can result in meaningful and immediate change for my patients. There have been many times in my life where I saw a patient for one visit and they reported after treatment that they hadn’t felt or functioned this well in weeks, months and on occasion, years.

So the question remains, are we a profession that can function without being physically present with our patient? If the answer is yes, then PT as it’s currently structured won’t survive. Are we just pushing for telehealth access because we want so badly to be thought of on the same level as primary care providers? If it’s good for them, then it must be good for us too. I think it’s long overdue we stop and think about the consequences to our profession before adopting the position that telehealth is the solution to our current woes.

If we continue to push for the ability to provide physical therapy via telehealth and bypass the need to be hands-on with our patients, we might be choosing to make ourselves and our profession irrelevant in the near future. Soon enough artificial intelligence will take over a large part of what we do, let’s not give the rest away too easily.

References

Nicholls, D. (2018, September 5). What’s the difference between a technician and an artist?. Critical Physiotherapy Network. https://criticalphysio.net/2018/05/09/whats-the-difference-between-a-technician-and-an-artist/
Rowe, M. (2019, August 23). Artificial intelligence in clinical practice: Implications for physiotherapy education. OpenPhysio. https://www.openphysiojournal.com/article/artificial-intelligence-in-clinical-practice-implications-for-physiotherapy-education/

Physical Therapy: Time to Stop and Get Directions!

Jon Waxham, PT — Mon, 01 Mar 2021 17:19:32 +0000

For far too long physical therapy has been meandering on auto-pilot, hoping things will work out. While we can all agree physical therapy is an essential component of healthcare, the path we are on has led to greater challenges and a less than rosy future for the profession. We need to take a hard look at who we are and where we want to go if PT wants to thrive in the future.

Where is Physical Therapy going?

I have been pondering this question a lot recently. It seems like we have been just driving down the road admiring the scenery without realizing where we are going. It is inevitable, every road comes to an end so to keep moving forward you need to routinely adjust course. Our current navigators (The APTA) seem happy just to be out on the road driving around. Driving for driving’s sake doesn’t actually take you anywhere specific.

Could it be that we can’t find the right road forward because the primary goal is too ambiguous, and we don’t have a clear path? “Transforming society by optimizing movement to improve the human experience” seems like a destination with an infinite number of directions that can be taken. If there’s no well defined path to accomplish this goal, then how can you determine if progress is being made? Maybe we should start with something more focused and attainable, like educating the public on the benefits of physical therapy. While it sounds simple enough, up until now we have had trouble getting that done.

Fractured identity

Heidi Jannenga wrote an excellent blog summing up some of our professions current challenges as identified during the 2020 Graham Sessions. She made two statements that really resonated with me. First, “we spend too much of our time trying to be everything to everyone.” Physical therapy has tried to show the world all of the things we can do by fracturing our profession into several sub-specialties. We look like a jack-of-all-trades, master of none. Just look at the APTA’s largest annual meeting, the Combined Sections Meeting. For those that don’t know, there is a keynote speech and then most attendees spread out into their sub-groups to discuss issues of greater importance to their specialty. The net effect is that the physical therapy profession has diversified itself too much to be able to unify under a single professional identity.

Secondly, she said, “We are the profession that’s an inch deep and a mile wide.” In essence, we are a very big puddle. So it would seem that we cover a lot of ground, but just sit still and stagnate. Why isn’t the planet covered in puddles? Because they are shallow, they evaporate, and they disappear.

That is essentially what is happening with physical therapy. Our reimbursement gradually declines, we can’t seem to get the message out about what we do to the public or other healthcare providers, other fitness/wellness groups (that get to operate outside of the insurance overlords) provide alternatives to our patients and we are slowly evaporating. If you don’t believe me, check out all the ways in which our profession has lost ground under the current leadership.

Let’s contrast that with the other end of the spectrum, being a profession that is narrowly focused and deep, like a river. Every drop of water in a river flows in the same direction. River’s carry tremendous amounts of energy and have tremendous power to reshape the face of the Earth. Is it time to stop sub-dividing physical therapy through specialization and come together under one unified identity? If we want to change the landscape, then the answer is yes.

This is us in a nutshell

The first question is then, who are we? We have been pondering this question for far too long. The best approach is to keep it simple. We improve physical function. There can be a thousand reasons why a person has impaired physical abilities such as pain, nervous system disease, acute trauma, etc. As a profession we get way too lost in the trees to see the forest. When it comes to communicating what we do, the message should be simple and direct, we improve physical function. When asked how we do that, we need to continue to keep it simple, we identify the reason you have impaired function and use a specific plan of intervention to improve it. When trying to market our profession, the general public doesn’t give a damn about the details of how we improve their function until we have evaluated them and are creating their individual treatment plan.

When trying to communicate what we do, it only creates confusion when we get into specifics. It is not beneficial to say we’re McKenzie trained, we are specialists in Neurodevelopmental Treatment, we do Instrument Assisted Soft Tissue Mobilization, we specialize in osteopathic treatment techniques, or we are neurology specialists, or acute care specialists, or sports specialists. That’s what we do or where we focus, not who we are. Every technique we use, or body system we treat is done with a singular purpose, to improve physical function. As a profession we need to create a single, unified identity if we want to change the landscape.

Sometimes wrong choices bring us to the right places.

Are we capable of uniting behind a single identity? To date the answer is no. I understand there has been a push to identify the physical therapy profession with the movement system. My thoughts about that can be summed up in a quote from Seinfeld when Jerry says his breakup with his girlfriend was mutual, “It’s weak. No one’s gonna buy it, and you shouldn’t be selling it.”

If our goal is really to keep our message simple, then attaching ourselves to an artificially constructed body system will only muddy the waters. Did it ever occur to anyone talk to, or do some focus group testing with the rest of the medical community to gauge their response to the idea of the movement system? It seems awfully naïve to think the rest of the healthcare world would just welcome this new movement system with open arms. Or did it ever occur to invite discussion and gather opinions from the over 75% of licensed PTs and PTAs that are not members of the APTA about adopting a position for the professional identity of us all? Might have been a good idea before jumping into the deep end.

A new way forward

If we agree that we can unite under a simple, unified identity then the next obvious question will be, how do we do it? For it to be successful there needs to be buy in from a vast majority of the profession. The only way to achieve that is to have an open discussion that invites opinions and includes discussion from everyone in our profession. Currently our professional association only represents about 21% of licensed PTs and PTAs. If something is going to get done, it needs to happen through a different platform outside of the association. Their reach is too limited and restricted to members only.

It may be time we hook our wagon to a new organization that chooses inclusion over exclusivity. Wouldn’t it be refreshing if there was a centralized place for all of our professional voices to be heard equally (PT and PTA) and where we could unite over a couple of simple, common goals? Goals such as creating a unified national (and global) brand, marketing the benefits of physical therapy, and sharing research and information that makes us all better informed.

All I know is that our puddle is drying up and that current leadership is unwilling or unable to change the course of our profession. We need to find a common identity and unite behind it if we are to change our future, and we need to have an organization with a different way of thinking that values inclusion so it can better guide the future for the greatest number of PTs and PTAs possible. When we can all get moving in the same direction and focus on simple, common goals, like a river we can change the landscape.

Is the American Physical Therapy Association failing us?

Jon Waxham, PT — Mon, 01 Feb 2021 18:06:31 +0000

As a physical therapist who is a 25-year member of the APTA and someone who cares deeply about the future of our profession, I ponder this question more each year. After the challenges our profession faced in 2020 and a lot of reflection, I decided it was time to try and answer that question. The conclusion I reached is that the APTA is no longer an effective leader for the physical therapy profession. I feel they have spread themselves too thin and lost their focus on their main mission, to support the members and to help the physical therapy profession thrive. I’ll present my case below and let you decide on your own.

Before I dive into specifics, I feel it is important to say that the APTA has done a lot of good for our profession, especially in the early days and through the mid-to-late twentieth century. There are a lot of genuinely good people that serve and work there. Having said that, the Association has failed to keep up with changing times. Most of you know the famous saying that insanity is doing the same thing over and over and expecting different results. That describes how we have approached the last 30 to 40 years in physical therapy. Expenses continue to rise, and reimbursement continues to fall. If we don’t commit to taking a hard, honest look in the mirror, we may not last much longer as a viable profession.

Reimbursement

Off all the issues that should be a priority for our national association, reimbursement should top the list. In this area I feel the APTA has been completely ineffective and continues to be reactive instead of proactive. Our profession is headed towards death by a thousand cuts. If you don’t know by now, The Centers for Medicare and Medicaid Services (a.k.a. CMS, or in other words Medicare) is the trend setter when it comes to payment policies for physical therapy. The private payers tend to follow CMS’s lead. Let’s look at policies affecting Medicare reimbursement that CMS has implemented in the last 25 years and let me know how many of these you would chalk up as wins.

1997: The Balanced Budget Act and the therapy cap

Under the BBA, two annual $1,500 caps were established, one for occupational therapy and one for physical therapy and speech therapy combined. While the cap was repealed (kind of, we still have a soft threshold), the administrative reporting implemented with the cap is still a requirement and moving past the $3,000 mark may trigger a targeted review by Medicare. The long and short of it is that for complex patients there is a chance we will not get reimbursed for services.

2007: The Physician Quality Reporting System (PQRS)

The PQRS (which started as Physician Quality Reporting Initiative, PQRI) was designed to track outcomes related to a series of outcome measures throughout the healthcare industry. Early participation was voluntary and was rewarded (if you met their threshold) with a modest 0.5% bonus of allowable, covered charges for the reporting period. By 2014 and beyond those not reporting data were penalized initially 1.5% increased to 2.0%. In true CMS fashion, the measures PT ended up reporting on had very little to do with providing data on patient outcomes and created an unreasonable administrative burden on outpatient PT providers.

2011: Multiple Procedure Payment Reduction (MPPR)

CMS decided that they were going cut the amount paid when more than one related procedure was done on the same treatment day. The APTA estimated that reimbursement will drop on average 6% to 7% because of this CMS policy. There were so many private insurers that also implemented the MPPR that the APTA use to provide a reference list of all of them, but that is no longer available. Not a legacy that the APTA would want to advertise. The APTA continues still today to assert that MPPS is a flawed policy but it remains in effect.

2018: Merit-based Incentive Payment System (MIPS)

The PQRS was discontinued and it’s reporting measures incorporated as part of the Merit-based Incentive Payment System. Basically, all but small practices (billing under $90,000 in part B charges, treating less than 200 Part B patients) must report on quality measures and improvement activities. The carrot on the end of the stick is a possible bonus from CMS. For 2021 the maximum possible incentive is 7.0% and the maximum penalty is -7.0%. Because the MIPS program must be budget neutral, the ACTUAL maximum incentive is 1.79%, but the penalty for a poor score is -7.0% (source: www.MDinteractive.com). Again, we are left with minimal to no incentive, large potential penalties, and are burdened with more administrative responsibilities that take away from actual patient care.

2021: “The Cut”

Most of you are well aware of the approximate 9% reduction in reimbursement facing physical therapy in 2021. Due to the Covid-19 pandemic and Congressional Relief legislation that cut is estimated to be about 3.6% (APTA, 12/22/20). We have a temporary stay of execution, but don’t have any illusions that the rest of the cut won’t get implemented. Despite efforts by the APTA over many months, CMS decided to go ahead with the cut. While I applaud the response and advocacy of the membership, the only reason we didn’t get completely crushed is because of the pandemic, not any successful lobbying attempts by the APTA.

2022: PTA Reimbursement Reduction

Starting in 2022, if a PTA provides more than 10% of a service then the fee for that service will be reduced by 15%. Again, despite any efforts on the part of the APTA, CMS is pushing ahead with this reduction.

In addition, there have been numerous adverse Correct Coding Initiative (CCI) editing decisions by CMS that have affected our ability to get reimbursed for specific code pairs provided during the same visit. While there may have been a 1% gain mixed in on an occasional year from Medicare, I believe the list above represents a pattern of significant losses, despite the advocacy efforts from the APTA.

According to John LaRosa at Market Research.com, the average net profit margin for an out-patient PT clinic is 14.6%. The CMS cuts above have certainly come close or exceeded the profit margin for treating Medicare patients. The next cut might be the final nail in our proverbial coffin.

My biggest question remains why they continue to use the same losing strategy year after year without trying something else.

Marketing and Brand Recognition

If reimbursement is priority 1, then marketing is priority 1A. All of us physical therapists, physical therapist assistants, physical therapy administrators and support personnel know the value we provide for our patients. BUT DOES ANYONE ELSE?

We have done a very poor job of explaining what we do and how it benefits our patients, to other healthcare providers and more importantly the public at large. I want to try a little experiment, have you ever heard of either of these phrases: “Got Milk?”, or “Beef, it’s what’s for dinner”? I will bet almost all of you will say yes to at least one of those. What do they have in common? They were marketing campaigns created for national boards/associations (California Milk Processor Board and National Cattlemen’s Beef Association respectively).

What is the great marketing campaign for our profession, www.choosePT.com. They describe the site as the official consumer information website of the APTA. I wanted to gauge how easy it is to find this consumer information website, so I conducted a brief experiment.

I went on the three popular search engines and did two simple searches that our potential future patients might ask. I documented the ranking position for any content hit for the APTA main website and for the ChoosePT website. The results can be seen below.

According to internet marketing company imFORZA, 75% of search engine users never scroll past the first page of search results (https://www.imforza.com/blog/8-seo-stats-that-are-hard-to-ignore/). How many searchers do you think ever make it to the ChoosePT website? Well, the APTA must not have time to focus on search engine optimization because of the employees and dollars focused on the print, radio, and television marketing campaigns. As Sheldon on the Big Bang Theory often asked, “that’s sarcasm, right?” In my over 25 years working in physical therapy, I have no recollection of any national marketing done for the PT profession.

We could learn a lesson that the pharmaceutical industry learned a long time ago, if you want to improve your business you need to cut out the middleman (the physicians) and take your message directly to the consumers. Every other commercial these days (for those of us still watching broadcast TV) is for a prescription medication. You see, they figured out that instead of their reps trying to convince MD’s to recommend their products, they would sell the benefit of their medication straight to the consumers. Then, the patients would go into the doctor’s office already informed and ask to try a specific medication. If I had a dollar for every time I heard, “Ask your doctor if … is right for you”, I’d be a rich man!

This is a strategy we could easily adopt with a national marketing campaign. Just imagine if a patient had seen about the benefits of physical therapy in an ad or commercial and went into their general practitioner’s office and told their doctor that they wanted to try PT.

I wanted to find out the importance the APTA currently puts into marketing and was pleased to see one of their four strategic goals is to: “Maximize Stakeholder Awareness of the Value of Physical Therapy”. One of the ways they intend to do this is to “Leverage the #ChoosePT campaign and ChoosePT.com to inform the public about the benefits of physical therapy”. If this is a prime strategy (see ranking chart above) the PT profession is poised to wither away in obscurity.

According to their 2019 annual report, the APTA spent 6.7 million dollars on Public Affairs. It would be helpful to have more transparency on how that money is being spent, especially with a continued lack of public awareness about what we do and how we can help.

If the APTA chooses to continue to follow the current marketing strategy (if there is one), then at least more collaboration with the medical professionals we rely on for referrals might boost business. I checked the APTA website to see who was listed as APTA Partners. There are a few good organizations such as The American College of Sports Medicine, The Arthritis Foundation, and the U.S. Department of Veterans Affairs, but no association with the American Medical Association or American Academy of Family Physicians, you know, the kind of partners needed to grow our business and our brand.

Participation in the Association

For an association to claim it represents the profession it would logically follow that a significant portion of the profession should support it and be involved. Unfortunately, with the APTA this is not the case. Let’s look at some of the numbers. There are over 100,000 members however, about one third of those are students required to join or having their dues paid by grants. The following chart shows the number of PTs and PTAs working in the U.S. and the number for each that are APTA members. As you can see, as of 2019 the APTA represents about 26% of all PTs and a little over 7% of all PTAs.

Despite the growing number of licensed PTs and PTAs, as of 2019 the participation rate is declining. A couple of observations, with only 21% of the profession represented, when it comes time for advocacy we are speaking with a very small voice and in the eyes of our elected representatives we are an insignificant portion of their constituency and not worthy of listening to. There are two things lawmakers respond to, money and votes. We either need to spend more, or speak with a larger voice. It is unlikely that we can spend as much as the insurance industry, but if we can increase our participation, we might improve (?) the chance lawmakers listen.

What have they done to increase participation?

While the APTA has tried to argue that it has increased its value to its members through modified services, a growing number of those in our profession think that membership just isn’t worth the cost. Annual membership dues are among the highest in the country for medical professionals. The chart below lists the APTA and a few other associations and their cost for membership.

For a little frame of reference here is the annual salary for each of the professional groups listed above and the annual cost of association membership as a percentage of their annual income.

It may be hard for the APTA to argue that they provide twice the value over the AOTA or the AMA for their members, and the argument they currently provide enough value for the cost of a membership seems to be a losing one. It’s logical to me that if you want to be the voice of the profession then you would want the highest level of participation, so your organization carries more weight. The APTA has never tried recruiting more members by lowering their annual dues. If the APTA cut their dues in half they might double (or more) the number of people willing to support our association. One way to lower the cost is to reconsider the requirement to subsidize the state chapters, it seems like an unnecessary cost. Especially considering that the other medical associations listed in our chart can function with no state membership requirement. The APTA could generate equal or increased revenue from memberships and have a stronger voice, but I guess we will never know if that strategy would work since they seem unwilling to explore it.

Mission & Governance

There are three major factors about how the APTA chooses to function that for the life of me I can’t understand.

First, The Mission Statement for the APTA is “Building a community that advances the profession of physical therapy to improve the health of society”. I don’t see any mention of the membership or their interests in that mission statement. How can you expect an association to make decisions in the best interest of its members if you don’t make it part of your mission to serve the members? For the sake of argument, let’s assume (you know how that usually ends up) that the needs of the members are hidden within the mission statement. We in physical therapy are taught to rely on data when making decisions about progress and changes to our plan, yet our association makes decisions about the best interest of their members without the benefit of data about member satisfaction. Based on my physical therapy education, I would say that is NOT the right way to measure progress and modify goals.

At least in the past we could provide some feedback through comments on the APTA website. It was interesting to note that when they rebranded and rebuilt their website, they turned off the comments section for any posts. I guess those comments were deemed unnecessary.

I will say after 25 years, in November 2020, I finally received an invitation to provide my opinion to the APTA through a survey. I expressed many of the same concerns to them that I bring up here. I don’t know how they plan to use that data or if they will make the results public, but at least they finally asked.

Second, the organizational structure and the procedures used to conduct association business are based on a model of governance that is over 230 years old! This is one of those instances when the APTA has failed to keep up with the times. We live in a digital age where facilitating comment and votes from all of the membership is an easy task. Why we continue to rely on State Delegates being elected, convening in a House of Delegates meeting where motions are brought to the floor and voted on seems like an arduous and archaic process.

In today’s physical therapy world, things occur and change on a month-to-month or even week-to-week basis. The current structure of the APTA doesn’t allow for the rapid response to constantly evolving circumstances. I believe the Association’s response to guidance during the Covid-19 pandemic is a perfect example. In the early days physical therapy professionals were crying out for some type of guidance regarding changes to procedures, whether to stay open or close, and how best to respond. The best advice the APTA could offer is use your best professional judgment.

Here is an excerpt from a statement from the APTA Board of Directors posted on March 17, 2020:

“As actions are taken across the country to reduce the spread of COVID-19, a virus that spreads easily from close contact, APTA encourages physical therapists to use their professional judgment to determine when, where, and how to provide care, with the understanding this is not the optimal environment for care, for anyone involved.”

And an excerpt from a letter posted by the APTA President on March 20, 2020:

“This is a challenging time to be in health care. I commend all those who are putting their own health at risk to treat their patients and clients who have immediate health needs. I also applaud those who are selflessly closing the doors to their practices because they have determined the risk of spreading COVID-19 outweighs the benefits of providing care that is not urgent. Both actions are heroic.”

Can you tell the best course of action from their advice? Not quite the kind of guidance you might expect from an organization that claims to be leading our profession. They did eventually provide guidance but only after watching how the profession and other health related agencies reacted and then forming an opinion. It was a case of closing the barn door after the horse got out.

Third, I have heard from my early days of PT school how important it is that we use evidence-based practice (EBP) and incorporate the latest research into our clinical decision making. I agree with this philosophy 100%, however every journal publishing PT research guards that information like it is a State secret. I understand there are costs to operating a journal, but the over-monetization of research results only serves to hinder one of the APTA’s strategic plan objectives: “Translate the latest research into tools and resources for practice”. Remember only 21% of our profession belong to the APTA which means only 1/5^th of our profession has access to the research in our primary professional resource, PT Journal. You then must be a member of each special section to gain further access to the research available through their specific journals, leading to even further restricted access to research.

I don’t understand why all the research done through the APTA and their Special Sections isn’t available to the entire profession, regardless of membership or not. The APTA’s document on Core Values for PTs and PTAs identifies altruism and collaboration as key values. Although it might cost a small amount of revenue, wouldn’t altruism dictate that making research accessible to everyone in our profession outweighs any monetary gain from selling it? Especially since EBP has been one of the highest priorities for our profession over the last few decades.

Pursuing Policies That Have Little Return On Investment

The APTA has chosen to expend time and resources on policies that don’t appear to provide the expected return on investment, such as the Doctor of Physical Therapy degree and adoption of the movement system.

There was a big rush to transition quickly from the Master’s level degree to a Doctoral level degree to usher in the new era of autonomous practice and primary care physical therapy. However, the APTA didn’t consider the practicality of the transition. With the transition came increased school costs, so now new PTs are coming out of school with crushing amounts of debt. A blog post entitled “Is a DPT degree worth it?” (from fifthwheelpt.com) examines the cost of becoming a physical therapist and a physical therapist assistant. Based on the amount of school and the associated cost, it will take a PT about 20 years to catch up to the PTA in career net earnings. Considering the high rate of burnout (see Burning and churning: Why PTs are leaving patient care, EIM Blog, July 2019), I would be surprised if a PT makes it 20 years to recoup the cost of that Doctoral degree. In addition, having some therapists call themselves doctor while many others don’t (out of choice or because they have a Bachelor’s or Master’s) just confuses people further. Maybe 20 years from now it won’t be an issue, but its hard to argue that more student loan debt and public confusion are helpful.

To pile onto the confusion, we have decided to try to associate ourselves with a body system that doesn’t actually exist. This transition has been a focus of the profession for 40+ years and I ask to what benefit? In 2013 the APTA officially adopted the Movement System as the foundation for physical therapist practice, education, and research. The goals included elevating the public’s perception of our profession by associating with the movement system, as well as to enhance the quality of care and promote the development of more meaningful diagnostic labels for physical therapy. From 1921 to 2013 we encountered significant challenges in educating the public in what we did using terminology they might understand, muscles, nerves, and bones. I can’t see how introducing the movement system will make things clearer for Mr. and Mrs. John Q. Public OR fellow medical professionals. Additionally, we have trouble getting reimbursed when we use currently recognized and accepted ICD-10 diagnosis codes. How do you think the AMA (who administers the code set) and insurance companies will react when we show up with a whole new code set specific to movement system diagnoses?

As a matter of philosophical point of view, pursuing these goals might be worthwhile pursuits but we are struggling to get by in the real world today. Like we always emphasize to PT and PTA students, you have to master the basics before moving on to more advanced concepts and techniques. As a profession, we have not mastered the basics of communicating who we are and what we do, so do we really need to go muddying the water further with more complex questions of identity?

As I stated in my opening, I feel there are several good people involved with the APTA. My beef is not with the people, but with the organization, the mission and the decisions being made. In my opinion the APTA suffers from two major flaws:

They have branched out into so many areas that they have undermined their own ability to be effective at any one of them. Our leadership should be focused on three priorities, reimbursement, marketing, and growing our knowledge base.
The APTA suffers from a concept known as paralysis by analysis. In other words, too much time thinking and studying and being reactive. When it comes to the health of our profession, we don’t need another study group or position statement. We need our leaders to be pro-active about today’s most important issues.

I think the KISS (Keep It Simple Stupid) principle can and should be the primary guiding principle for our profession until we have started to show some progress. Let’s get the word out about what we do, let’s develop and use effective research to prove what we do is effective, and let’s fight to get reimbursed appropriately for what we do. When we are winning those battles, we can pursue more lofty professional goals.

I didn’t choose to write this just to complain. My goal is to determine if others feel the way I do and to hopefully be an agent of change to help PT thrive again. If the APTA is unwilling or unable to reassess and make changes, then perhaps the time has come for our profession to consider other alternatives for leadership and representation. I would love to see your thoughts either way, so please participate in our poll and/or leave a comment if you feel motivated to do so.

Note: There is a poll embedded within this post, please visit the site to participate in this post's poll.

Thank you for taking the time to read, provide your opinion, and for caring about the future of our great profession.

Physical Therapy Career Guide

Jon Waxham, PT — Tue, 20 Oct 2020 19:29:34 +0000

Here is all the information you need to find out if a career in physical therapy is right for you. If you like to learn about anatomy, pathology and how the body functions, have a desire to help people, and find the idea of working in the medical field exciting then a career in physical therapy might be right for you. Let’s look at the types of jobs available, the education needed for each and where the profession can take you.

What are the different types of jobs in physical therapy?

There are three primary job titles for people that work in physical therapy, a physical therapist (PT), a physical therapist assistant (PTA), and a physical therapy technician. The PT and the PTA are both licensed health care providers that require graduation from an accredited college program and passing of a licensure exam. The physical therapy technician does not have a license and does not have specific educational requirements. Each of these jobs are very different.

The job title with the greatest responsibility (and therefore the longest education) is the physical therapist. Physical therapists are professionals that are licensed by the state in which they work. They are the first person to interact with a patient when they are referred to physical therapy. They are responsible for evaluating the patient, arriving at a diagnosis, and developing a plan of care for treatment. The physical therapist will then treat directly or choose to utilize the physical therapist assistant to provide treatment to the patient.

The physical therapist assistant is also a licensed health care provider. They work under the direction and supervision of the physical therapist and assist the PT in the treatment of the patient. A physical therapist assistant reviews the plan of care established by the PT and then provides a variety of treatments to help the patient get better and reach their physical therapy goals.

A physical therapy technician is a support person that works under the supervision of the physical therapist and assists the PT and/or PTA as they provide treatment. While there are some certificate programs that teach you the basics of how to be a PT technician, most of the time PT techs are trained on the job. PT technicians are also used to perform many other functions related to maintaining the physical therapy department and equipment. Generally, those that work as PT techs take the position to gain experience in the field before applying to a PT or PTA education program.

How much school will I need?

It requires 7 years (4 years undergraduate and 3 years of graduate) of college to become a physical therapist and 2 to 2 ½ years of college to become a physical therapist assistant. Working as a physical therapist or physical therapist assistant require graduation from an accredited program. Accreditation means an educational program has met and continues to meet the official formal requirements outlined by the accrediting organization. For both PTs and PTAs, graduation from an accredited program is necessary to sit for the licensure exam. So, if you chose to attend a non-accredited program you would not be eligible to get your license or work as a PT or PTA.

Physical therapist programs are graduate level programs which require a Bachelor’s degree before you can apply. Once accepted, a PT program usually lasts 3 years. Therefore, the total amount of college required is seven years. Graduates of a physical therapy program earn an entry-level doctorate degree in physical therapy. Physical therapist assistant programs require two or two and a half years and graduates earn an Associate’s level degree. Most, but not all PTA programs are housed in two-year colleges. Working as a physical therapy technician does not require any additional education.

How much does school cost?

Physical Therapist School

The average total cost of tuition and fees (living expenses and books not included) to earn a Doctor of Physical Therapy degree is $102,874. To estimate the costs of PT school it is necessary to include the cost of an undergraduate degree with the cost of the physical therapy program. According to the National Center for Education Statistics, the average tuition cost for a Bachelor’s degree at a public 4-year institution is about $36,800 (2018-19). The cost of tuition in 2019-20 to earn a Physical Therapy degree from a public institution is $66,074 as reported by the Commission on Accreditation in Physical Therapy Education (CAPTE).

Physical Therapist Assistant School

The average cost of tuition and fees (not including living expenses or books) to earn an Associates in Physical Therapist Assistant is $16,459. PTA programs are about two and a half years long on average and a majority are in 2-year colleges so the cost of tuition tends to be lower. In the most common program format students must take pre-requisite courses for a semester before applying to the program. The average cost for a semester at a public 2-year college is $3,700. CAPTE reports as of 2019-20 the average cost for the PTA program is $12,759. For more information about the cost of PT/PTA school you can follow this link to CAPTE’s website, http://www.capteonline.org/AggregateProgramData

An important factor to consider for both degrees is the current number of states that offer free tuition for community college or in some cases two years’ worth of tuition at a 4-year college. According to U.S. News there are at least 24 states that offer free community college for low to middle income families. Many other states offer some break on tuition for Associate degrees. These programs make it possible to reduce the cost of a physical therapy degree or even possibly allow you to get your physical therapist assistant degree for free!

What will I learn in school for physical therapy?

At the core of both PT and PTA curricula are classes that teach you about human anatomy and function, pathology, about data collection techniques, intervention (treatment) techniques, and working on the healthcare team. To better understand what is taught it is helpful to look at the 5 components of physical therapy.

A PT must be able to perform all 5 components, but the PTA is only responsible for one, intervention. The biggest difference is that physical therapists need to be able to examine, evaluate and diagnose a patient. The PT’s responsibility requires much more in-depth education about the medical diagnosis and management of people. PTs spend a great deal of time learning about testing techniques to evaluate all the body systems and how to use that information to arrive at a diagnosis and treatment plan. The PTA education focuses primarily on intervention techniques because that is their role in the PT-PTA team. In simpler terms, PTs learn how to diagnose a problem, create a treatment plan for that problem, and then fix the problem. PTAs learn how to fix the problem.

Can I find a job in physical therapy?

If you are worried about being able to find a job after getting your PT or PTA degree, you don’t need to. CAPTE collects outcome date for all PT and PTA programs and reports that in 2019-20, 99% of PT program graduates and 98% of PTA program graduates were employed in the year following graduation. The Bureau of Labor Statistics estimates the need for physical therapists will grow by 18% and the need for physical therapist assistants and PT techs to increase by 29% between 2019 and 2029. The good news is that once you graduate, you can find a job and the demand for physical therapists and physical therapist assistants will remain high for at least the next decade. This is due in part to the growing number of older people. The number of Americans over age 65 is expected to double over the next 40 years. In addition, people are much more active in their later years and want to be able to stay active. They will actively seek out physical therapy services to make sure that they continue to function at the highest level possible, and that is what we do.

How much can I make working in physical therapy?

The Bureau of Labor Statistics reports that as of 2019 the average annual salary for physical therapists is $89,440, for physical therapist assistants $58,790, and for physical therapy technicians $26,240. There are many factors that go into determining your potential annual income such as the healthcare setting, amount of experience, and any specialized training or advanced certifications. PTs and PTAs working in Nursing and residential care facilities generally make more money than those working in a hospital or outpatient physical therapy office. In addition, pay will vary significantly based on geographical location and the supply and demand in that area. As with many jobs the more experience you have, the more money you are likely to make. You can compare the annual salaries listed above with the starting salaries for new graduates. PayScale reports the average salary at entry-level (no experience) is $66,740 for a physical therapist and $44,689 for a physical therapist assistant. One way to earn some extra money is to pursue additional certifications while you are working. There are many opportunities to become certified in a specialty area of physical therapy such as orthopedics, geriatrics, or neurology. Having advanced training can also give you an edge when negotiating salary or applying for a new job.

For more information on salaries and job outlook, you can explore the Bureau of Labor Statistics website here: https://www.bls.gov/ooh/healthcare/

Where can I work in physical therapy?

One of the really great things about a career in physical therapy is that you can choose to work in a large variety of settings including in-patient facilities, out-patient facilities, schools, patient’s homes, or businesses. One of the goals of a PT or PTA education is to make sure you have clinical experiences in a variety of settings. Here are examples of the kinds of places physical therapy services are provided:

Out-patient private practices employ the most PTs and PTAs with acute care hospitals second. Another option is to work as a traveling PT or PTA. A traveler works on temporary assignments that typically last a few months in locations all over the country. This can be a wonderful way to explore new places and work settings while working in physical therapy. If you wanted to work as a traveling PT provider, you would arrange your assignments through an agency.

As previously mentioned, you can choose to work in any of these environments OR if you get burned out in one type of setting you can decide to go in a completely different direction. This mobility gives you an opportunity to re-invent your career if things start getting stale.

So, if you are trying to decide if a career in physical therapy might be right for you, ask yourself these questions:

- - Do you like learning about how the human body works?
  - Does the idea of working in the medical field excite you?
  - Do you want to help people?

If you answered yes to any of these questions, then physical therapy might be the right choice for you.