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.