“Unscrewing” #physicaltherapy: Love the Profession, Hate the Job

My last post was regarding #APTACSM and an encouragement for our profession to not “screw up the whiskey” with respect to making sure we fulfill the dreams and aspiration of our next generation of physical therapists and physical therapy assistants.  This post will focus on one way we can all agree with-cut the red tape!

I had a conversation with a young PT at #APTACSM who was considering residency and had some questions. He had been working just short of a year in an outpatient clinic and also did home health on weekends of course to help pay off debt from the ridiculous cost of graduate school.  I asked him about his work, interests, and very specifically if the position and the company that he worked for matched his perceptions and aspirations.  He proceeded to tell me that he never anticipated the amount of paperwork, rules, requirements, and insurance idiosyncrasies.  In regards to paperwork, it was 25 min on most new patients and even longer on medicare patients. His employer provided good systems and training and he was optimistic about the future but his enthusiasm for healthcare generally was suppressed by external demands. In remarkable insight, he tells me initial paperwork is so voluminous that most PT’s at his center don’t want to see new patients because of the additional work it entails.

He loves the profession but hates his job.

Which reminds me, in 31years, I have yet to meet the PT who entered the profession to do paperwork instead of patient care, the PT who wanted to become an expert in compliance and medicare regulations, the PT who gets jazzed up about plans of care, 8 minute rule, modifiers, and discharge summaries.

Regardless of your political persuasion, it is time for all of us to unite in a campaign to kill regulations.  Last week, President Trump signed an executive order directing federal agencies to create reform task forces which will evaluate federal rules and recommend whether to keep, repeal, or change them. In effect, the administration wants officials to reduce expensive or unnecessary rules. When he signed the executive order, Trump claimed “excessive regulation is killing jobs”.  With respect to #physicaltherapy, it is likely more of “killing job joy” through frustration, burnout, exasperation, and dismay for the externalities that remove care from healthcare.  We have to get this pendulum swinging the other way.

Isn’t this something our profession can rally behind? We should push APTA and our other trade organizations to jump on this bandwagon and positively impact providers who are are overbudened. Let’s get rid of plans of care, rues that block direct access in medicare, obliterate most to the technical compliance requirements, and derail excessive documentation mandates.  Lest you think the chances of  success are low, I would point out a similar campaign in our Commonwealth of Kentucky called the “Red Tape Reduction”. Led by Gov Matt Bevin, you simply go to this website and make recommendations.  Have to applaud our OT counterparts in KY as they are on the next agenda and you can see the progress this initiative has had.  Yes, I submitted to get rid of CON requirements for #physicaltherapy, juris prudence exams for licensure, and CEU requirements (another post for another time but there is zero evidence of their impact).

Let’s make the PT job great again!!




11 responses to ““Unscrewing” #physicaltherapy: Love the Profession, Hate the Job

  1. David Self says:

    Incredibly relevant words. At least bi-monthly I get a call from one of my classmates (Class of 2015) either discussing other career options or doing something more “creative” due to burnout, often citing the same reasons you mentioned in the post. I think that in any profession, those being prepared for it can’t help but be at least a little utopian in believing what the career is “actually” like. But then, after entering in and seeing the ins and outs of how work moves forward — which is, almost always deflating — there’s a drift to one of two continuums: stoicism or cynicism.

    I think young physical therapists are experiencing this likely more than they ever have in the past (though being in my twenties, I’m likely quite ignorant of the validity of this claim). It’s critical that the broader community work tirelessly to offer a convincing existential antidote to the profession, lest the new breed of staff PT’s last a few years and then go to working part-time, driving uber, and dabbling in real estate.

    Finally, as an aside, I often find that the message to my generation of PT’s to encourage them in this struggle is either:

    1. ) Start your own practice (dangerous broadstroke advice)
    2. ) Start another company “like I did” (insert {tech} {media} {etc.})

    I think these two pieces of advice apply to perhaps 5% of the population. I tell my friends all the time: in many ways those two things are the easier way out; as it’s a lot harder to know the world of being a staff PT, with all it’s flaws and burdens, but to still choose to enter in and love it — for the sake of the common good. As in any facet of life, it’s a much heavier lift to change your perspective then to presume a change in circumstances is always the right answer. It’s the former part of the conversation I’m interested in participating in — the latter has plenty of voices.

  2. Michael Frost says:

    I am a P.T. in my 27th year of practice and am sick of the paperwork required of me in the home health care arena. I am ready to quit the field and move on to something else because of it . If I am required to do an “Oasis” open on a patient , it takes 3 hours in the home and 3 more doing paperwork at night when I get home . I am thoroughly and completely disgusted with it ,what B.S. . Anybody that goes into this field is an idiot. paperwork has ruined our profession!!!

  3. charles says:

    It’s not just paperwork. The PT killed the PT profession. Feel free to look up my post “Are You A Healer or a Sellout?” Sept 2004 Advance PT Mag.

    Most of you–not all of you but most–have destroyed this profession. In Home Health most rush through the treatments. I’ve come behind many who do nothing but check vitals and leave. In skilled you dovetail which is the same as the multiple patients at a time you see in OP. In most settings a lot of treatment is done by techs. Why do most of you even bother going to manual courses that you will hardly use once back in the clinic? Yes I do have the right to talk–I have stood my ground one on one and have so for seventeen years. Most of you didn’t. Period.

    You keep seeing the “chronic pain patient” over and over instead of discharging them because they won’t get better because they are obese and sedentary. You let MDs run over you with the same orders for the same patients that you can’t fix instead of discharging them as you just saw them a month ago.

    You think you’re doctors. You’re not. You’re entry level at graduation–not an advanced Masters of Manual Therapy like they have in, say, Australia. A specialty doctor goes to medical school then specializes. You don’t–you go to entry level PT school with extended internships to make up the time. And before you talk about imaging and med courses we had those sections in our BS and Masters programs as well and an end of term research paper which most of you are trying to pass off as a legitimate thesis. If you’re teaching you call yourself Doctor. You don’t try to pass that off to the public in the field unless you actually are one. But I guess if you are 130K in debt and now realize that was strategically stupid then at least calling yourself doctor makes you feel better about the matter.

    The paperwork is the least of the problems. The PT profession’s lack of ethics is the reason we are mostly a charlatan field now.

    1. Kevin says:

      Charles – I gotta call you out. You have done a good job at ridiculing our profession for sure and make some good points. However, it’s hard to tell from your blog if you are even practicing at all. It’s pretty easy to slam the PT profession if you spend your time traveling and writing instead of working 50 weeks a year in the trenches. Ironically, some of the misgivings of our profession that you noted exist IMO due to the unnecessary paperwork burden put on PTs by the government, insurance companies, and facilities. Admittedly, our profession had done this to ourselves and now we are feeling the pain of years of giving in to requests for more paperwork and less treatment time. Maybe you could share how you manage the paperwork load in your practice? (Yep, it would be great if we could all take cash only in our practices and do just the minimal amount of paperwork!)

      1. charles says:

        It’s not the paperwork Kevin–you can’t get the paperwork done because you are letting managers stack patients on you. The profession continues to let the managers schedule a patient every twenty minutes or two or three at a time while you let aides run them through exercises. I have plenty of time for paperwork because if I fell behind I catch up on a cancel. Most of you are sitting there by your notepads while you have one patient on the nustep for fifteen minutes, one on estim and another doing exercises with an aide. It’s not a paperwork issue it is a lack of will to stand up to your managers. You know what I did when they tried to schedule two at once with me a long time ago—I sent one home. Then I threatened to bring the state in for interfering with my clinical judgement. What could all of you do? Threaten to walk out. I’ve seen that done once and the management got the point. But most of you won’t even acknowledge there is a problem to begin with. Ask yourself this Kevin–are you seeing one on one for 45 minutes with patients? If not then you’re the problem. But don’t fret too much-you’re in the majority of our despicable profession.

    2. Robert H. says:

      The APTA failed PT’s when it failed to eradicate POPTS. Here in the Chicago area POPTS are all over the place. Other choices are Athletico or ATT.

    3. Leland says:

      I completely agree with you about the PT profession. In my opinion, the APTA is useless and elitist organization. It has been said, one should never go further in dept than they will make in the given carrier. Yet DPT students regularly do just that! Just because the Pharmacist profession went from a BS to MS and eventually a Doctorate, does not mean other professions can follow the model. The salaries in Pharmacy dictated that an increase in education was warranted. It is ass backwards to think that increasing the education requirements will result in increased salaries.
      I was a PT for 7 years before I was fed up with the profession and went back to medical school. It was a grind and took a toll on my family. However, there is no comparison with my job satisfaction today versus when I was a PT. Money isn’t everything but every professional wants to feel that their efforts in education are reimbursed appropriately. I no longer have to worry about money and that is a relief. For those PTs that love the profession and couldn’t picture doing anything else…more power to you. But for myself, PT as a career was a huge letdown.

  4. Cindy Pearson says:

    I’m pretty sure PTs here breeze through their new patient paperwork in 5 minutes or less, and someone said they are hiring full or part time, masters or Doctorate:

  5. Kristi says:

    I completely left the field of PT because I was tired of bullied by government regulations and large corporations that took over all of the good private practices due to the hyper-regulation. The government destroyed the profession. I hope our congressmen can get their act together and support Trump’s efforts. They failed us on repealing the ACA; what a shame for PTs and patients.

    1. Jennifer says:

      I guarantee, you haven’t been practicing long enough. Changes have been happening way before ACA. The Medicare caps and changes in the late 90’s had this profession at a stand still, and trust me, most private insurance follows suit. And it’s not just PT’s , it’s physicians too. Why do you think you wait an hour in a doctors office? Because they have you quadruple booked–trying to do more with less. But it’s not just the government’s fault. The mandatory DPT, with no regard for pt ratios, management worried about the almighty dollar, new PT’s crippling debt, not enough emphasis on really doing research instead of just reading it, and a small percent in the APTA delegating for the rest of us. Lobby for the profession! Do not just blame the government.

  6. I graduated in 2010 and was ready to leave patient care by 2013. Not because I didn’t enjoy treating patients, but because I constantly felt spread thin, and was sick of unrealistic productivity expectations. I finally made my move in 2015 and now am a full-time copywriter.

    After writing an article on PT burnout that went viral, I wound up starting a website for PTs who want to explore non-clinical options (thenonclinicalpt.com). Since it launched in 10/2017, it has grown surprisingly quickly, and many of my former colleagues and classmates have reached out to discuss options for themselves.

    I’d love to see the APTA supporting PTs taking on non-clinical leadership roles. The more we de-stigmatize leveraging the DPT creatively, the more visibility other medical professionals (and the general public) can gain into the extent of our education and our value in all facets of healthcare delivery, including tech and innovation.

Leave a Reply

Your email address will not be published. Required fields are marked *