For a long time, physical therapists have been the indie bands of the healthcare scene: super talented, a bit obscure, and often misunderstood by the masses. But with the US healthcare system on the cusp of transitioning to a value-based payment paradigm, it’s time for us to go from the record store to the radio. After all, we’ve got a lot of value to offer the mainstream healthcare fanbase—they just don’t know how good we are yet. If the discussions that unfolded during this year’s Graham Sessions are any indication, we’ve got all the tools we need to hit it big; now, it’s just a matter of getting everyone in the profession on the same page, playing the same tune.
For those of you who aren’t familiar with the Graham Sessions, the basic idea behind this annual meeting is to spark meaningful discussions about the PT profession and the various issues facing PTs. Essentially, it’s a jam session—but instead of rockstars rattling off guitar riffs, it’s PTs rattling off insightful perspectives on where PT is going and how therapists can survive and thrive in the face of change. It’s an event that I’m truly honored to be a part of, and I was even more excited about this year’s meeting, as it took place right in my own backyard here in Phoenix.
We covered a lot of ground over the course of one and a half days, but the majority of the conversations seemed to revolve around the theme of growth: as a profession, as an industry, and as individual leaders. Just like last year, I left the 2016 Graham Sessions high on inspiration. And after taking a few days to digest all of the incredible ideas I had the privilege of hearing, I felt inspired to put pen to paper—er, fingers to a keyboard—to share my thoughts with you. After all, for these ideas to have any real impact, we’ve got to get ’em out on the national airwaves, so to speak. So, with that in mind, here are my top takeaways from the 2016 Graham Sessions:
1. Stop fighting for the 7%, and start focusing on the 93%.
Within the first five minutes of the meeting, one of the speakers presented a very telling—and concerning—statistic: out of all the patients with a diagnosis that would indicate benefit from seeing a physical therapist first (i.e., before they seek out any other type of medical care), only 7% actually start their care journeys with physical therapy. In that speaker’s words, “That’s an absolute disaster.” I couldn’t agree more. And from my perspective, it’s actually a disaster on two levels:
- It means there are a lot of patients out there whose needs aren’t being met. They could be getting better—but instead, they’ve gotten sucked into a winding labyrinth of medical care that may or may not end with physical therapy. And that ends up costing our healthcare system—and the patient—a pretty penny.
- It means we’ve all gotten so caught up in competing for that 7% minority that we’ve become blind to the opportunity that exists within the 93% majority. It’s like we’re all trying to steal the fishing pole out of each other’s hands when we could be working together to not only build a giant net, but also take that net to where the fish are. After all, if we, as a profession, can reach potential patients at a population level—rather than an individual level—then we can change the public’s perception of who we are and what we do. More than that: we can create—and scale—the perception we want. A common complaint among those in our industry is that “we have a brand problem”—and that we’re stuck in our ways when it comes to our strategies for getting new patients through our clinic doors. But, if we can embrace a different marketing approach—one that allows us to go straight to the consumer rather than relying exclusively on physician referrals—then we can escape the “injury rehabilitationist” pigeonhole that we’ve inadvertently confined ourselves to, and claim the market we should have been pursuing all along: that is, “anyone with a body,” as one attendee so succinctly put it.
2. Be team players.
Speaking of market, with healthcare in general—and the insurance system in particular—in the throes of reform, the manner in which patients access physical therapy is changing. As part of the massive effort to move the American healthcare system closer to achieving the Triple Aim (i.e., higher quality care at a lower cost with better patient satisfaction), the ACA and other reform initiatives are driving the adoption of team-based care models like accountable care organizations (ACOs) and patient-centered medical homes. And that, in turn, means that physical therapists—and all other types of providers, for that matter—must start looking beyond the traditional private practice setup.
That’s not to say private practice is dead—on the contrary, I think private practitioners have a lot of upside in the emerging team-driven care environment. But to capitalize on that opportunity, we have to not only learn to function as team players, but also get our teammates (i.e., practitioners in other disciplines) to recognize the value we bring to the lineup. That way, they’ll not only know when to pass us the ball, but they’ll also trust us to make the right play—thus giving the entire team the best possible chance of scoring.
Let’s face it: we don’t have the greatest reputation when it comes to playing nice in the sandbox. But, to build trust with our peers, we first have to trust ourselves—and that means stepping up and claiming our rightful place as primary care practitioners. Because even though we’ve achieved some level of direct access in all 50 states, we have yet to fully embrace a direct access mindset. We don’t yet see ourselves as the neuromuscular experts—at least not across the board. And that’s a huge problem if we want the rest of the healthcare community to see physical therapy as a valuable care option to be leveraged, rather than an expense to be reduced. To convince everyone, once and for all, that we’re not out of our league—to prove that we deserve a spot on the care team roster, we’ve got to show confidence in our ability to make crucial game-time decisions. That means knowing when to shoot, when to pass, and when to take a seat on the bench. When we use “what’s best for the patient” as our decision-making North Star, we can more clearly—and more honestly—decipher when physical therapy isn’t the right answer for a particular patient. And we have to be okay with that. But, when we are certain that therapy is the best route of treatment, we need to fight for our position—and deliver a slam dunk every time.
3. Establish standards and hold ourselves accountable for meeting them.
Ask five different people about their personal experiences with physical therapy, and you’ll likely get five different responses. Some patients can’t say enough good things about the top-notch care and attention they received; others express disappointment in their treatment or the person who provided it. And while it’s true that you can’t make every single patient happy every single visit, one of the themes from this year’s Graham Sessions that truly resonated with me is the problem of practice variation in the PT space. It’s an interesting issue, considering that PTs have earned a reputation as staunch advocates of evidence-based practice. Historically speaking, though, we’ve been pretty laissez-faire when it comes to standardizing that practice. We’ve failed to establish any sort of objective quality guidelines, let alone develop universal tools for measuring and monitoring adherence to such guidelines across the profession. The result: there is no consistency in care administration and quality from one provider to the next. (And we wonder why we struggle so much to define who we are and what we do.)
In my opinion—and this is something that also was brought up during this year’s meeting—this problem starts with the lack of standardization in PT education. The degree of variation in curriculum and content hour requirements from one school to the next—which, according to one attendee, amounts to differences of thousands of hours—blew my mind. And while “more” doesn’t necessarily equal “better,” discrepancies that large are tough to ignore.
But it’s not just the in-classroom curriculum that’s the issue; we also have to think about what students are experiencing during their clinicals. After all, this is where the real hands-on learning happens, and student PTs and new grads—or “fresh PTs—tend to replicate whatever they see in the clinic. So, if those clinics aren’t being held accountable to any type of standard, there’s no way of knowing what habits—good or bad—students are picking up. Thus, the whole cycle perpetuates—and unless we implement some type of universal framework to eliminate the inconsistencies plaguing our profession, history will continue to repeat itself. After all, every time a headline like this hits the wire—which seems to happen on a regular basis—it further damages our status as reputable providers.
4. Understand that men and women approach leadership differently.
Men and women are different; it’s a tale as old as time (or, at least as old as Men are from Mars, Women are from Venus). And those differences—in the way we think, communicate, build relationships, and solve problems—have led to biases. Unfortunately, those biases have become so deeply ingrained that it’s tough to recognize that they even exist, let alone figure out how to overcome them. But in the professional realm—especially the professional PT realm—it’s absolutely critical that we do overcome them. Why? Because regardless of industry, any business that has a one-dimensional approach to leadership cannot thrive in a multi-dimensional world. And I think that’s especially true in the PT space, which is why I was so glad women’s leadership was a topic of conversation at this year’s Graham Sessions.
As one speaker noted, approximately 70% of physical therapists are women; however, only 30% of those in positions of leadership within the PT industry are women. That’s a huge discrepancy in representation, and it elicited a huge variety of viewpoints. John Childs and I started a similar discussion here on the EIM Blog a couple of years ago that stirred quite a controversy. The same themes that emerged from that discussion seemed to drive the conversation during this year’s Graham Sessions: some attendees pointed to a lack of effort to keep women in the workforce “through their childbearing years”; others cautioned against equating success with rising to positions of power. I, for my part, believe the key to changing the above-cited stats lies in changing viewpoints—not only in women, but also in men. For more women to step into leadership roles, they have to recognize their own leadership potential. And that’s not always easy, especially considering that women’s approach to leadership often looks a lot different than their male counterparts. But even though the road to getting more women into leadership positions might seem long and difficult, it’s absolutely worth the effort. According to recently-published research, companies with women leaders and board members are more successful than those companies with no women in high-level positions. And that’s because one of the key drivers of innovation—and thus, success—is the diversity of ideas.
But if the majority of PT leadership positions are held by men, then where can aspiring women leaders look for inspiration? For real change to happen, male leaders must first understand how women lead; then, they must learn to recognize—and develop—leadership qualities in women. Mentorship is critical, and that means both men and women must step up to the plate to help women—including fresh PTs—find a seat at the table. Furthermore, men must take an honest look at their own gender biases. Because whether they realize it or not, those biases influence their behavior toward women—and that behavior could inadvertently prevent or discourage women from advancing to the leadership roles they want and deserve.
At the end of the day, PTs are already rockstars. You know it; I know it. And we have a lot of loyal fans out there who know it, too. But, why settle for a gold album when we could go platinum? It’s time for us to be the headlining act we’re capable of being. Let’s rock.
About the Author
Heidi Jannenga PT, DPT, ATC/L is the president and co-founder of WebPT, the leading practice management solution for physical, occupational, and speech therapists. Heidi leads WebPT’s product vision, company culture, and branding efforts, while advocating for the physical therapy profession on a national scale. She co-founded WebPT after recognizing the need for a more sophisticated industry-specific EMR platform and has since guided the company through exponential growth, while garnering national recognition. Heidi brings with her more than 15 years of experience as a physical therapist and multi-clinic site director as well as a passion for healthcare innovation, entrepreneurship, and leadership.
An active member of the sports and private practice sections of the APTA, Heidi advocates for independent rehab therapy businesses, speaks as a subject-matter expert at industry conferences and events, and participates in local and national technology, entrepreneurship, and women-in-leadership seminars. In 2014, Heidi was appointed to the PT-PAC Board of Trustees. She also serves as a mentor to physical therapy students and local entrepreneurs and leverages her platform to promote the importance of diversity, company culture, and overall business acumen for private practice rehab therapy professionals.
Heidi was a collegiate basketball player at the University of California, Davis, and remains a lifelong fan of the Aggies. She graduated with a bachelor’s degree in biological sciences and exercise physiology, went on to earn her master’s degree in physical therapy at the Institute of Physical Therapy in St. Augustine, Florida, and obtained her doctorate of physical therapy through Evidence in Motion. When she’s not enjoying time with her daughter Ava, Heidi is perfecting her Spanish, practicing yoga, or hiking one of her favorite Phoenix trails.