I Still Believe Physical Therapy is the Worst Kept Secret in Healthcare

I still believe physical therapy is the WORST kept secret in healthcare. Last year I wrote a blog titled “Physical Therapy – The WORST Kept Secret in Healthcare” which allowed for some great discussion by the readers on the topic of physical therapy and where we fit into the healthcare system.   This blog post followed an open discussion called the “Chelan Chat” at the Washington State Private Practice Special Interest Group (PPSIG) spring conference at Lake Chelan, WA.  The ‘Chelan Chat’ is a twist on the Annual Graham Sessions hosted by the Institute of Private Practice Physical Therapy and was moderated by Steve Anderson. This year I was asked to present an “I believe” speech, that I would like to share with everyone here as a means to continue the discussion and a call to action. Here it goes…

I believe we are in the “story” business as physical therapists. We spend countless hours listening to patient stories, stories told by other therapists, stories told by doctors, stories told by friends and stories told by loved ones. We also tell a lot of stories too about weak muscles, weak cores and my favorite the infamous sacroiliac joint slippage! A vast majority of people fail to recognize the difference between a story and fact. In fact, most people view stories as facts and as Carnegie Mellon research shows, our stories carry far more weight than facts. In reality, a story is what we tell ourselves about the facts, it is not real. Our point of view is not the truth, it is our perspective. And perspective is based on our knowledge, previous beliefs, environment, the context or space we are in, our mood, our emotions, social pressures, and so on. Essentially our perspective is based on where we are at in life when we make up the story. I believe it is therefore important to remember that our perspective is just one angle on the facts, it is not the only story. Facts do not determine our point of view, our stories do.

So, I would like to invite you into my story on why I believe physical therapy is the WORST kept secret in healthcare.

Most of you are familiar with the common phrase “the best kept secret”. Being the best kept secret is great when you want to keep something a secret, such as your favorite coffee shop, restaurant or favorite place to vacation. However, when it comes to the role of physical therapy in healthcare, I believe that we are still a SECRET to a majority of consumers. This was highlighted in 2007 by Stephanie Carter and John Rizzo when they demonstrated that less than 7% of patients with musculoskeletal conditions utilize outpatient physical therapy services and again in 2012 in the Fritz and Childs study.

So, hopefully you are sitting there asking yourselves, why are we a secret? I believe we are the worst kept secret in healthcare for four main reasons:

  1. We have an identify crisis
  2. We suck at marketing
  3. We don’t know how to sell our product
  4. We are bullies to our brothers and sisters

Despite our shortcomings as a profession, I believe we are the BEST profession in a broken healthcare system and it is our time to move into the limelight.

 

I believe we have an identify crisis- In 2 words how would you describe a physical therapist?

With a sample of convenience of like-minded individuals at PPSIG, when asked how would you describe physical therapy, I received several answers across the board. There was no cohesion in our professional identify and I believe there would be even more disparity if we were to ask the broader community of over 203,000 physical therapists. Lisa Saladin, PT, PhD, FAPTA, said, as described in the guiding principle “identity” of APTA’s vision for the profession, The human movement system is our professional identity. We need to own this!

Physical therapists like to identify themselves with their training or specialty rather than their profession. I hear this on a regular basis “I am a Maitland therapist” “I am a Feldenkrais therapist” “I am a woman’s health therapist” and the list goes on. Are we ashamed of our profession? Have we tarnished our brand?

I believe that we lack cohesion in what physical therapy really means and that many therapists find that the professional title of “physical therapy” does not well define them. I believe this is why they choose to tout their merits over their profession. Ever since I attended my first house of delegates, I have always said, the beauty and the beast of physical therapy is the heterogeneity of our profession. Jeff Moore said it best, “The heterogeneity of physical therapy is killing our brand”. Unlike Starbucks, we lack consistency and this lack of consistency makes our brand unsellable and often times makes it difficult for our profession to be taken seriously by consumers and the rest of the medical profession. I believe that we owe it to our profession to not burry it’s merits in our alphabet soup, but rather highlight that we are proud to be a physical therapist first and foremost. I believe that our profession should define us and it is time that we band together as the MOVEMENT SPECIALISTS as our professional identify.

I believe we are the best profession.

 

We suck at marketing and our consumer does not know what we do.

I believe our consumers do not know what we do and if we lack an identity it is very hard to sell our product. Physical Therapy is not sexy, nothing says this more than the 7% who utilize our services. What about the other 93%?!? I agree, it is tough to compete with big firm advertising. Think about it, next time you are watching television, what are consumers being drawn to? Yep, drugs, surgery, and cool gizmos that make false claims and come with an attractive partner and a puppy. Where is PT? We cannot even compete with copper wear who pays Brett Favre ridiculous amounts of money to sell their products on ESPN. And people buy them because they believe it will solve their problems. I believe we can do better.

I believe APTA’s #ChoosePT is a nice start and a step in the right direction, but does not carry the weight to move the needle. Their campaigns largely focus on statistics and pain and fail to recognize the patients real problem (their internal motivator), the reason they seek our services, their function and participation. A direct quote from the tv ad is “physical therapist treat pain with movement and exercise”.   Contrast this with the Advil commercials that shows people of all ages doing the things they love with the slogan of “what pain? Nothing works stronger and longer than Advil liquid gels”. What are you going to choose as the consumer?

I believe the vast majority of physical therapy companies waste their marketing budgets, marketing their services to potential physician referral sources. In doing so, they are trying to tell the physicians why their clinic is better than clinic XYZ down the street, killing our brand. I believe we do this because it is the thing we have always done. But let me remind you, what got us here will not get us to where we are going. I believe that the future of marketing in PT is direct to consumer marketing, cutting out the middle man. I believe in doing so, our profession will be liberated from the shackles that have held us back for so many years. I believe marketing to the consumer a consistent brand will allow our profession to grab a larger share of the healthcare pie. I believe it is time that we band together to showcase our great profession.

I believe we are the best profession.

 

We don’t know how to sell our product.

I believe that the vast majority of physical therapists undersell what we do. We sell services not products. Imagine just for a moment if “health” was a product like a good bottle of wine, rather than a service. If it was a product, our consumer could read the label, touch the bottle, taste it. I believe that if therapy was like wine we would sell a whole lot of wine, but it is not. Physical therapy is a service and a service that lacks consistency. Using sales and marketing campaigns based on emotional stories will outperform anything else and as a profession we need to learn how to better sell our product like a good bottle of wine.

I believe we expect our patients to buy our product, sight unseen and without even getting to sample it. Furthermore, most of us lack the ability to show our patient this value. I believe we fail as a profession to tell our consumer what is really going on, how long it will take to get better and what can be done about it. We just expect our customer to hand over their credit card and pay the $40 copay until we determine we no longer want to see them. There is no proof in this than the front office person who is TRAINED to schedule patients out for several weeks before they have even met the PT. Do we not value our own product? I believe that our product is superior than anything out their and we need to show our patients this value. We need to use test-retest of meaningful positions and activities. We need to keep our attention and their care focused on their internal drivers for seeking our care in the first place. We need to measure our outcomes. If we can do all this, we bring incredible value to our client that will keep them coming back for more.

Why on earth do we DISCHARGE our patients!?! What do you call a business that cannot wait to get their customer in the door, sells them something, and then says, I hope to never see you again? Physical therapists! Why do we do this? I believe we should focus on our customers who love our service and become their life PT. Get them back into our “store” as their first stop when they have a movement dysfunction.

I believe we are the best profession.

 

We are bullies to our brothers and sisters

Why can we not play nicely in the sandbox? Physical therapists are so quick to criticize each other, go to battle over internal issues and politics and put each other down. I see this on a daily basis with turf wars surrounding care models, use of assistive personnel, the use of interventions like dry-needling and the list can go on. I believe what matters to our patients has little to do with our care model or our interventions. In fact, John Childs showed us in his 2015 study of 750,000 patients that even the worst physical therapy was still far superior to no PT at all. I believe that we are our own worst enemy. We are not the enemy. I believe imaging, drugs, surgery and injections are the enemy. Often, my patients have been through the medical merry-go-round by the time I see them and for some of them, they are still spinning. They have been wronged by so many people in healthcare and in life, we are not the enemy, our healthcare system is. So, why on earth are we the shy kid in the classroom (called healthcare), yet we are the bully in the physical therapy sandbox, willing to kick, scratch and beat each other up over trivial things such as the interventions we use and care models we view as ideal. I believe we all have our own story which is based off our own point of view and we somehow are lead to believe that everyone should think the same way we do. I know I am victim of my own biases. I believe we are wasting an incredible opportunity to help a great deal more. When will we recognize that our POWER as a profession has little to do with what we do with our patients and has EVERYTHING to do with TIME, TRUST and delivering a consistent experience of HOPE, COMPASSION and EMPATHY that helps them on their road to recovery. We are wasting an incredible opportunity to help a great deal more!

Physical therapy is still the WORST kept secret in healthcare. Physical therapy is the best profession. I believe it is time we share our secret with the world. Thanks for reading my story.

 

@brettneilsondpt

17 responses to “I Still Believe Physical Therapy is the Worst Kept Secret in Healthcare

  1. Teresa Schuemann says:

    Fantastic article Brett! Thank you for writing and sharing your profound thoughts. I think it is high time to focus on what our message is as PTs and then SPREAD THE WORD, holding no secrets back. I like “Best Profession” slogan. Most other professions do not sell their brand for their specialty. We need to unite to get consumers to utilize physical therapy and INTERNALLY recommend our colleagues and peers based on specialty practice that is effective. Clients should find a Physical therapist and the PT should get that client to the person BEST suited to be effective when a referral is necessary to attain client goal’s and excellent functional outcomes!

    1. Brett Neilson says:

      Teresa, thanks for taking the time to leave a comment. I could not agree more with your affirmations. I also completely agree that PT’s need to be better about referring patients to other PTs or healthcare professionals. When we do not, we do this typically for self-interest and it makes our profession look desperate, as if we cannot each get enough patients. This is why we need to learn how to engage with the 93% we have yet to connect with. In order to do this, we need to learn how to educate (not market) the public about what we do and how we can help them with their problem. By problem, I am not talking about back pain or knee pain, etc, but their movement dysfunction that is holding them back from playing with their grandkids or spending a day on the golf course, etc. We need to learn how to better connect with people on their internal motivators and use this to help them make better decisions about their healthcare and health in general.

      Thanks again for your thoughts.

  2. John;
    So right on!!!
    Brand, passion, accountability. I think of those three things need to change for PT to become a known as a provider. Jeff is right our diffuse and confusing brand is no help.
    Reduced variation and increased standardization will help to define the brand. We must be able to answer for the patient/customer the one thing they can count on from a physical therapist for treatment of xyz condition. We must have a brand promise.
    Passion is about treating the customer with confidence and being able to engage them. Some patients and conditions can be a trial course of treatment, but the level of knowledge, skill, and training should give us confidence in providing a solution to many, many patients.
    Being accountable to an outcome, a result of treatment will help us break out of the volume based model we now accept. If we cannot be accountable to a result, we have nothing that differentiates us from other providers, and therefore nothing to sell. If we aren’t accountable to an outcome, we can only blame ourselves for settling for low payment. • Here’s a great TED talk by Casey Brown’s . . . Know Your Worth, and Then Ask for It.
    https://www.ted.com/talks/casey_brown_know_your_worth_and_then_ask_for_it#t-1338
    No one will pay us what we want unless we know what we are worth, and tell the customer what we are worth. It does not mean stating the dollar value of your service right off the bat. It means stating the value of your service in their terms; “you will be able to do . . . you can get back to what makes you happy . . . . You will do again what gives you excitement . . . .”
    Stating our value is necessary for patient engagement. We can’t expect the customer to fill in the gaps for us, We must show them and demonstrate why and how we are different from other providers; and why we are the best choice for them.

  3. Dr.p.Bhaskaran says:

    Great insight into the profession of physical therapy. I thought it was like this only in India but its the same everywhere. Very aplty put by my friend Brett. Thank u

    1. Thanks for reading. It is unfortunate to learn that things are the same in India, but comforting to know this is a world wide problem. We can all band together as a profession to better help the people we serve. Thanks again for your comment!

  4. Edwin Meelhuysen says:

    Excellent article overall, and I totally agree with most of it. You did lose me with your statement, “I believe imaging, drugs, surgery and injections are the enemy. Often, my patients have been through the medical merry-go-round by the time I see them and for some of them, they are still spinning. They have been wronged by so many people in healthcare and in life, we are not the enemy, our healthcare system is.” I think if we are going to achieve the status we desire in the healthcare community, we need to do all the things you mentioned previously in the article, all the while truly being experts. The rest of the providers will grow in their appreciation and respect of us as we communicate intelligently with them and succeed in caring for patients.. We need to not only talk about our value, but demonstrate it with the patients. I have had a number of mentors during my career and those that added the most to the growth of our profession have the respect of their medical provider community. I do not think any of them have gained that by treating them or what they do, as “the enemy,” I certainly have not. Let evidence based care weed out what does not work. I believe that when we truly have the patient as our focus, not ourselves, we will be willing to help that patient to achieve success, even if it is outside of ourselves. That combined with excellence and skill and the tactics you outlined will help us grow as a profession.
    Thanks for the thoughts.

  5. Lakshmikanth VP. says:

    We spend countless hours listening to patient stories, stories told by other therapists, stories told by doctors, stories told by friends and stories told by loved ones. We also tell a lot of stories too about weak muscles, weak cores and my favorite the infamous sacroiliac joint slippage!

    Yeah we hear lot of stories about the fact where to rely on.
    Customer keeps on relying who reduce the pain and improve the function. Where it come PT or a drug which is better for their recovery….
    Some of them lacking in this to promote the best is physical therapy….
    It’s a good article to look into and eye opening…….

    1. Lakshmikanth VP,

      You highlight an excellent point. As Paul Gough would say, we need to learn how to help our patients make better decisions about their health and healthcare. I believe this is the single most impactful thing we can do NOW. This is an uphill battle to compete with pharma. We need to become consumers of the literature in marketing and communication to better get our message across. I would recommend the book “Predictably Irrational” by Dan Ariely as a great starting point for anyone.

  6. Mary Riley, PT says:

    Thank you for this powerful message. As a PT with a great deal of respect for the profession and my colleagues, this conversation is long overdue. Follow best practices, refer when a patient requires different expertise than currently in your toolbox and mentor as well as receive mentorship when needed.

    On the topic of how we treat one another professionally, this conversation needs to begin in school. Identify mentors or be a mentor are the options. Criticizing is the easy option when we identify something we feel needs change. Action is much more difficult. Treat all with respect and keep the lines of communication open.

    Thanks for framing up this conversation and urging us to action.

  7. Alagappan says:

    This is one of the best article which deals our present situation. we as a whole professionals have to change our work etiquette. identity is the major problem . most of us tries to show our patients that we are doing something new on our application and really get strucked on our ground level. for me for sure we have to work on improving our marketing skills.as the years progress physiotherapy is going to be the key for many conditions. its going to be a much helpful one for the whole world. thanks for your article once again brett

  8. Matthew says:

    Brett,
    Thanks for the relevant posting.

    First;

    I am curious what it means to be a “movement specialist.” As a physical therapist with many letters after their name, I’m still unsure what this means. How can a profession try to “TM” movement? Movement screens have been shown to provide little to no benefit. The postural and movement “dysfunctions” promoted have little if any validity and anyone in exercise or rehab professions can adapt/modify movements for comfort.

    https://www.nsca.com/education/articles/ptq/corrective-exercise-trap/

    http://bjsm.bmj.com/content/early/2017/05/16/bjsports-2016-097307

    https://www.somasimple.com/forums/showthread.php?t=26964

    https://www.ncbi.nlm.nih.gov/pubmed/28360142

    Second,

    How do we market what many cannot define is our product?

    I think Erik Meira hits it on the head when he writes:

    “A physical therapist is a licensed healthcare professional trained in rehabilitation and the optimization of function after injury or disease whom you can see directly without the need for a physician’s referral.”

    http://thesciencept.com/ethics-of-healthcare-advertising/

    One could add in the value as force multipliers (if we decided to pursue it) with direct access, differential diagnosis and members of a healthcare team that refers to appropriate providers when warranted.

    Physical rehabilitation is who we are and what we do. This exists from the NICU to hospice. From homemakers to elite athlete. For those with orthopedic, cardiovascular, neurological or oncological conditions throughout the lifespan. At some point in our life, its likely we’ll all need physical rehabilitation.

    So I say out with titles that carry little in the way of validity (movement specialists identifying “dysfunctions”) and in with what we do. Get people back to who they were/want to be without gimmicks/gadgets but with sound physical rehabilitation.

  9. Dr. Akshay Mehta says:

    Very important article and the ensuing discussion. As a cardiologist husband of an eminent physiotherapist wife, I realize the value of all points discussed. My suggestion is to publish: in lay press, in medical journals, thru social media, writing books, etc. People do not know the magic you all are doing.

  10. Alexander says:

    The problem is that most
    Physical therapist don’t care
    about patients,they care about
    money,most of physical therapist use old methods of therapy and not willing to try
    new one,they are scared to get out of box. As a result are bad outcomes. And another things that we deal with patients not with customers. I think this is big difference. I’m from Russia,
    Worked as a clinical exercise therapist for 15 years,we used new method for people who experienced spinal cord injury,tried to apply my knowledge in Canada,but nobody was interested,they didn’t care about it.And I think that first of all physical therapist should change their attitude,they should be focused on a result,on helping people,but not just think about money.The more positive results you gonna get the more attractive you will be for people.

    1. Dr.Akanksha Kaushal (P.T) says:

      Totally agree with u sir.if the patient is having no result with one physiotherapist , instead of going to another therapist he will think that physiotherapy is of no use.

  11. Liza Tan says:

    You hit it up front and center.

  12. senthil says:

    Thought provoking writing. Yes we are movement specialist. We should brand ourselves.

  13. A fantastic write up about the tug of war in our profession is well explained.
    The area of marketing on our service is well said comparing to a “wine bottle ” product sale.
    The interesting part of your say brand promotion and quality care was superb.
    Would like to add up that our care towards an individual as branded under physiotherapy/physicaltherapy takes a public it’s as same as any other provide it.
    On watching a movie or listening to a music it gives joy/relaxation and not to take away anything beyond it.
    Internal defaming of our own colleagues comes of jealous in the standard and quality of care.
    Looking forward more from your dear

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