Debt and the DPT: What Went Wrong?

Last month, my team and I released the results of our second annual State of Rehab Therapy industry survey, and while some of our findings aligned with expectations, there were several data points that left us pondering—and worrying about—potential implications for the profession as a whole. One such finding: The astounding levels of debt reported by DPT students. According to our survey results—which you can see for yourself here—the majority of PT students (more than half) will have more than $70,000 in student loan debt at the time of graduation, and over one-third will owe more than $100,000.

Salary expectations for new grads aren’t on par with other healthcare industry peers.

And if triple-digit student debt figures aren’t enough to make your head spin, bear in mind that most starting therapist salaries pale in comparison to the price tag of a PT education. In fact, according to our survey, nearly 75% of students expect to earn between $60,001 and $80,000 during their first PT job after graduation—which also aligns with current industry salary averages. To put that into perspective, the amount of debt medical students incur throughout their schooling is often comparable or slightly higher than that of PT students. However, med students can expect to earn starting salaries about three times higher than that of the average physical therapist.

Despite this, physical therapists still love what they do.

Now, regardless of where you stand in the debate over the true value of the DPT, one thing remains constant: on the whole, physical therapists continue to cite high levels of job satisfaction. In fact, our survey results revealed that, for the most part, PTs enjoy their work and find it highly rewarding. However, many respondents also expressed concern over the direction the profession—as well as the healthcare industry in general—is heading.

This shouldn’t come as a surprise. After all, there’s never been a better time to be a PT in terms of job availability and overall demand. Between the aging population and the rising cost of health care on the consumer end, patients with neuromusculoskeletal disorders are seeking out effective, lasting, and less-risky alternatives to surgery and other invasive treatments. At the same time, increased regulatory burden and lower reimbursements have driven many practices to increase productivity and revenue by incorporating cash-based wellness services in order to keep their heads above water. This isn’t necessarily a bad thing; however, I’m sure most of us didn’t spend seven years and thousands of dollars on schooling to lead exercise classes or provide massages.

Some therapists question whether elevating PT education requirements was the right move.

With such a massive wage-to-debt disparity, a number of PTs have found themselves asking the same sorts of questions:

  • Was moving the requirement from MPT to DPT really in our best interest?
  • Do PT students really need to be in school for seven years?

The answers vary greatly depending on the individual, but some would contend that the profession was better off before the change. And at first glance, it’s hard to fault that observation. For one thing, it’s driven PT grads even further into debt—and has increased their overall workload without increasing their skillset in any measurable way. Despite this, I believe that ultimately, the decision to level-up from MPT to DPT was the right one. After all, we’ve earned that “doctor” title; we are more than capable of not only assessing, diagnosing, and treating musculoskeletal conditions, but also directing our patients’ care journeys and advocating on their behalf.

Perhaps most importantly, the doctor title elevates our status and perception in a patient-focused world that recognizes titles. Part of the reason we implemented the DPT was to bring physical therapists up to “doctor” status in the eyes of the greater medical community as well as the general public—and to use that label as a branding mechanism to inform the layperson of our status as front-line care providers. (Unfortunately, many PTs have not embraced this title, instead shying away from calling themselves “doctors.” And in my opinion, that’s truly a shame.) And considering the fact that the switch to the DPT curriculum has not correlated to increased payment rates, it feels like all that work and effort has garnered little to nothing in return. So, in order to reap the benefits of a doctorate-level degree, I firmly believe that all DPTs must embrace the doctor title. This may be an uncomfortable adjustment at first, but it’s a crucial step toward informing the average patient-consumer about the value of the care PTs provide. (A good example of this is the shift in the public’s perception of chiropractors once they took on the doctor title.)

To me, all of this begs the question: At what point do students start considering the debt ramifications—and the apparent lack of ROI—and as a result, begin to avoid the DPT route? Or, will the culture of student loan acceptance among undergrad and postgraduate programs—a phenomenon that’s certainly not unique to DPT programs—cause massive, widespread burnout down the road? Either way, the future of our profession is, in my opinion, hanging in the balance. We’ve got a lot at stake here, and we must come together to address this problem—sooner rather than later. And that starts with awareness. (For a couple of ideas on how we can get the educational reform ball rolling, check out this blog post I recently wrote.)

Physical therapy education is still worth the price of admission—up to a certain point.

Now, I’m not saying that a career in physical therapy is 100% not worth the financial investment. And research conducted at the Carver College of Medicine at The University of Iowa seems to back that up. This study concluded that PT school is a good investment “up to a certain amount of student debt.” According to the study, with the average debt level reported by recent US DPT graduates ($86,563), physical therapy’s net present value “was higher than occupational therapy, optometry, veterinary medicine, and chiropractic but lower than dentistry, pharmacy, nurse practitioner, physician assistant, and all medical specialties,” all of which have a significantly higher expected starting wage. At $150,000 debt—which about one-third of our own survey respondents reported owing—physical therapy’s net per value “falls below all careers except veterinary medicine and chiropractic,” and students who report $200,000 worth of student loan debt are unlikely to achieve necessary repayment benchmarks. And beyond $266,000 of loan debt, physical therapy’s net present value doesn’t even exceed that of a bachelor’s degree.

DPT students report higher satisfaction with their education compared to students in other healthcare disciplines.

So, if the value of the DPT falls short of many other healthcare degrees, then why are DPT class sizes increasing year over year? Well, consider this: despite the lower perceived value of their program, PT students tend to report an overall better educational experience than their medical peers. According to a different study from the University of Iowa, DPT students “reported significantly higher ratings of the educational emotional climate and student-faculty interactions” than students in MD programs. Furthermore, the study found that DPT programs have significantly lower burnout rates than medical programs do.

To me, this only reaffirms something I believe most PTs view as a universal truth: despite the seemingly-endless struggle for proper recognition, payment, and pro-PT legislation, this profession is still incredibly rewarding. They say if you do what you love, you’ll never have to work a day in your life. And I believe that a genuine love of the work we do as physical therapists points to why so many of us elect to stay in this profession—and why the number of new grads entering the field continues to grow. However, I also believe that this love will only take us so far if potential DPT candidates no longer see value in the degree when other fields require the same amount of schooling (or less)—but won’t result in mountains of debt that will follow them for the rest of their lives.

At the end of the day, one thing is clear: our profession—and its approach to education—is in dire need of a change. While groups like the APTA push for educational reform, their efforts will only be hampered if PTs are not active participants in that change, too. (Specifically, physical therapists can be a part of the discourse by joining efforts such as the National Student Conclave (NSC) or attending the Education Leadership Conference.) Ultimately, it’s on us to create a prosperous future for ourselves—and I think that’s a goal we can all get behind.

About the Author

Heidi Jannenga PT, DPT, ATC, 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.

21 responses to “Debt and the DPT: What Went Wrong?

  1. Patrick says:

    Thank you for the great post, it was a very interesting read. This is something that I have pondered myself quite often. I think the answer to the question, “What went wrong?”, has less to do with education, and more to do with the wages that physical therapists earn. I have worked in the physical therapy field now for 6 years and in that time my salary has not increased much. I have interviewed for many different jobs and I have been surprised how low the offers often are. I was involved in an interview where, the interviewer told me that the best offer they could make me was $5000 less than what I was currently making with no benefits. She told me the reason was that, “As a PT you just can expect to make that much anymore.” And this person was a PT! We all know that salaries are tied to reimbursements, and that to get higher reimbursement we need to show our value, etc. etc., but the more we talk about it, the worse this problem seems to get. Where this went wrong was when we decided we would take less and less, and now we are sliding down that slippery slope.

  2. Tyler says:

    My comment is in regards to “the doctors titles.” Unfortunately, in our world, many outside of DPT world “fat-shame” DPT student and novice practitioners. I remember as a student, I had a PT with his MPT tell our class “don’t think just because you have your doctorate, you are better than me.” He is not the only case where this came into play. Also, to refer to yourself as a “doctor” around an MD will result in a catastrophic pedestal kick. I think we need to acclaim ourselves as specialist; however, the world has not adapted to the change.

    1. Lola Carson says:

      I agree that PT’s should be considered specialist. I also think you should not have to pay the price of a 3 year doctorates program to become a specialist. The educational system is taking advantage of students.

  3. Cody Thompson says:

    Great post/article here. You’re right; the cost-benefit analysis needs to be done by every potential PT student. Don’t get me wrong, I believe in our profession with all of my heart, and love being a PT. But because of reimbursement changes, the workforce has started shifting towards the use of PTAs for treatments (in many settings) leaving PTs to be paper pushers or administrators. The fun stuff is in the patients!

    I’ve taught in PT and PTA education and am now an administrator, and when I go guest speak to classes of potential healthcare classes, I make sure they see the data before they leap. PT school = $70k in debt on avg, and possibly more (to your point). PTA school (public) = 9-11k in debt. PT can make 70k out of school, PTA can make 55k. Sometimes the costs DON’T outweigh the benefits. And becoming a PTA in certain states and settings can be lucrative enough to pay off the debt quickly, and save for PT school (since so many PTAs come in with BS degrees already). The market is, and has, shifted. And while I do believe that what EIM is doing with 2 yr programs that are a little less costly in places, the entire profession in PT education needs to wake up! We’re going to price ourselves out of the market! Thanks for this great article!

  4. Physical therapist’s salaries can only increase when our profession is allowed the innovation to occur that has taken place in medicine. A physician,for example, can supervise aides, physicians assistants, nurses and nurse practitioners thereby allowing expanded access to care. PTs, on the other hand, are limited, in my opinion, by onerous and restrictive regulations that restricts access to patient care as well as reimbursement. All of this continues at a time when the large baby boomer demographics need access to service. Until we can innovate, salaries will stagnate regardless of graduate degree conferred. One silver lining perhaps, is that at least the large student loans incurred due to the DPT degree helps retain PTs longer in the workforce.

    1. Could not agree more – we continue to fight over the 10% that access PT and should focus on the 90% that need our services but don’t know we exist or have been restricted to our services.
      Re: silver lining – disagree from the comments our discussion has provoked – many students state that they are bailing after a couple of years to other industries because they can’t pay the loans back fast enough. Hate to lose our best and brightest.

      1. Tim W says:

        There are three issues the APTA did not take inconsideration. Reimbursement improvements with the increased presence of the DPT instead of accepting what CMS values our services. The public has no real understanding of what we can truly do unless the MD refers to the PT. Lastly, depending on state rules, PT’s are not able to align with companies to endorse like physicians. If the idea is considering PT’s as specialists and the ‘doctor’ added on the name offers this opportunity, why are states and the APTA not expanding our presence for the public to consider other forms of our need for our services? This presents that our scope is too narrow. Nurses and physicians have a wide spread of opportunities to be needed by the public without the public thinking too hard about them. Physical therapists? No idea until a person is injured or in the hospitals. I can not speak for other PT’s, but it is hard to support organizations that speak about a direction that sounds great at rallies and conferences, but at the end of the day, pay and debt are real issues in this country. Until the APTA looks at the business of reimbursement as a priority, PT students will all do the same thing. That is, support with the schools pushing for that support, but stop supporting when debt hits them and they are not able to be called ‘doctor’ in the hospitals after graduation.

  5. James C says:

    This article hits on a lot of important points. To add to the discussion, there needs to be better regulation on the opening of new PT schools and the class sizes of existing schools. A close eye should be kept on supply and demand for physical therapists and PTA’s forecasted based on accurate projections for future PT needs. These forecasts need to be based on the changing healthcare climate, including hard caps for OP visits and managed orthopedic care becoming more common practices. As physical therapy companies grow larger and larger, less of a value is being placed on experience and advanced coursework and more of a value on new grads and PTA’s who can bill the same but don’t demand as high of a salary. This will displace mid and older clinicians from the market. The high debt to income ratio will likely discourage the majority of young clinicians from pursuing advanced degrees and certifications.

    As for the DPT. It was nothing more than a cash grab on the part of schools to justify one more year of enrollment and tuition fees. The original enthusiasm for direct access is waning as the practical complexities of implementing it and reimbursing for it are exposed.

    We can all agree that physical therapy was, is, and likely always will be a great profession that empowers people to help heal themselves. However, in my opinion we have done a poor job of managing the long term sustainability of the profession.

  6. Courtney says:

    Maybe it’s time for a class action lawsuit against APTA for demanding that we go to a Doctorate, which allowed the PT schools to jack up their prices and charge for a year of school when we are not even on campus… and to top it off, the fact that the APTA has never increased my reimbursement rate. So based on false practice by APTA to demand Doctorate, and their failure to have us paid at a rate based on level of education and experience. So, to me it looks like APTA is out to line their friends pockets in the education system, but not improve work or pay conditions for the DPT………

    1. Josh says:

      This is the very mentality that is hurting the profession. The APTA was right in mandating the doctorate, it is now failing to control the implementation of the result into the industry. Chriopactors have branded and lobbied extreamily well as chiropractic physicians, the DPT is currently in an identity crisis. In order to improve reimbursement practitioners must embrace the Doctor of Physical therapy title, maintain and expand scope of practice, and respect the MD medical scope of practice. The APTA must do more to protect private practice and encourage autonomy between the providers unlike the route of the DC.

  7. charles says:

    You didn’t earn a legitimate doctorate. You went to PT school. In earlier times PT school was junior and senior year with summers included no breaks. Or it was senior year and a year after and a Master’s. Now you go to PT school post an unrelated degree after which the program extended internships to justify the three years. You are not a specialty “doctor” who went to medical school. You went to entry level PT school. We assessed and evaluated with the license granted as a PT whether Masters or BS–having the doctorate didn’t suddenly create that as you said above. We had an imaging section and a pharmo section. We differentially diagnosed the entire way through school in every course. We had research methods and an end of term paper. You did not do a real caliber graduate student “thesis.” You do not teach lower level courses as a grad student does. You do not do real orals as a grad student does—and again don’t point to end of term tests that we all did or the paper you turned in that we all did as well. You did not go to PT school then advanced PT school or specialize.
    But you did get 150K in debt so maybe it makes you feel better to say you’re a doctor when you certainly aren’t. In the academic environment feel free to use that term to teach. Don’t do it in the healthcare practice community—you look ridiculous

    1. Margaret Gonzales-Charles says:

      And so many students I have had lately are brainwashed, thinking they have superior skills than someone with many years of experience and ongoing con ed. As you said they have no more actual PT courses/skills than I did when I graduated with a BS 30 years ago.

      1. Jim says:

        That’s interesting and I agree, I often have not even recently minted DPTs ask me where did you learn that manual or neuro rehabilitation technique that was taught at my bachelors program at Stony Brook. I happen to believe that the DPT was a form of grade inflation and that therapists haven’t really been elevated academically or in any other way. However, the specialist designations are quite rigorous and I have a lot of respect for their clinical expertise.

  8. mare says:

    I have long felt that the DPT was a way for schools to bring in more money. When speaking with DPT students, I always made sure to discuss what they were going to owe once graduating vs what they would be paid going into the work force initially. As a business person that is hiring a new grad vs an experienced PT (w/ a MS or BS), there is no comparison. DPT are a fancy name for entry level PT. Adding a year of classes and a D in front of one’s credentials does not make that person a Doctor in the eyes of many. They are an entry level PT and in today’s world, that is how they should and will be paid. Yes, I am a PT, with a Master’s Degree, but I also have a background in running a business. If the APTA was serious about a doctorate program, they should have made the last year of school strictly clinical work where students earn hands on experience. What really is the value of the extra coursework they received in the final year when CEU’s can cover many of the topics studied. In today’s healthcare world, costs of doing business continue to climb while reimbursements continue to decrease or rise only slightly. Plus, PT’s require more and more time for documentation (most often directed by insurance companies) to be paid. There are now some insurance companies that will not pay for the services of a PTA. Which brings me to one more question involving the PT field. Why are PTA students not required to have a BS with a 4 yr education?

  9. We can blame APTA all we want. Maybe the move to DPT wasn’t a good move after all. It’s easy to say this now, and it’s easy to say the schools did this just to make more money. But I find these cheap arguments. I honestly think APTA thought the extra education and the new name would help expand PT’s scope of practice. It didn’t, but it was worth a shot.

    You can say that PT schools are “gouging” students, but it’s students who sign the dotted line. No one is forcing these students to go to PT school. These students have had 100-200 observation hours before going into the profession. The high cost of education is not a secret. They know that the average private school is now $105k+ for three years (before room and board). Enrollment is up. The profession is hot. Why should PT schools lower costs when demand is so high and people are willing to pay the price?

    PT school would be way more valuable if they trained PT’s how to monetize their skills. I got 2 credits of business in PT school and 4 credits in modalities. That’s a problem. If students are going $150k into debt, they better have some business skills. PT school trains students to be employees, no businesspeople. It needs to be the opposite. If I could make $100k net my first year as a business owner, then maybe PT school would be worth it.

  10. Cristine says:

    I was amazed to see this article inaccurately compare the debt of med school students to that of PT students, the debts are nowhere near the same, and lets not forget the years of residency during which doctors are not paid anywhere near a full salary.

    That’s not to say debt isn’t a problem for everyone, but it’s disingenuous to pretend this is a problem exclusive to PT students.

    “In 2016, the average medical school debt was up to $190,000, with about 25% of graduates carrying debts higher than $200,000.”

    1. Mark says:

      The difference is 200k of debt at 300k salary is a massively different than 100k debt at 70k. Not only in regards to the debt:income ratio but also the absolute salary figure itself. 200k really isn’t that difficult to pay off when you’re making 300k a year.

      1. Grateful says:

        Thank you

  11. Eileen Wu says:

    I am apprehensive about encouraging our techs to pursue a career in physical therapy, given the ROI for PT education. What are other ways in which we can try to help our future coworkers not be so burdened by debt? Why is it that we as PTs are still unable to participate in the National Health Service Corp to qualify for loan repayment programs? How can we help to make that a reality? Here is the new link to the student conclave:

  12. Karen Hoffman says:

    This article hit home. My daughter will be graduating with her BS in Athletic Training, and is considering the field of PT, post-graduation. She ended up preferring the rehab aspects of AT, as opposed to the emergency care aspect. When we looked at programs, we were stunned at the price tag. Not willing to sign on for $100,000 in debt (easy to do, even living at home) we began to explore PTA as an option. While she doesn’t love the idea of attending a community college for two years (feeling like it’s a step down after getting her BS), she will probably be able to waive many of the general ed classes (Bio, A & P, etc.) and come out paying less than 10K. It seems the PTA salaries we are seeing in job listings are decent, and she’ll be able to do what she finds interesting and move forward financially. Definitely would love to hear from PTAs or PTs on the field of PTA, good and bad!

  13. Michael Pinnix says:

    I’ve seen many changes in the my 30+ years experience as a PTA, working in Texas. From one year licensure for $55 and no CEU requirement, to 2 yr license renewal for $110 plus 20 CEUs, to the current requirements. I’ve loved every minute of my patient care experiences over the years and have grown to loathe the ever growing demand for documentation to support the clinical side. Yes, I do understand the reason behind it, but, for me, it is truly the one aspect of the profession that can, at times, make me question how much longer I want to treat patients. Fortunately, that thought only lasts until my next patient shows up.
    As pointed out in an earlier comment, I too am concerned about PTA education level. With the push to an entry level Doctor of Physical Therapy degree, why hasn’t the PTA curriculum been elevated to Bachelor’s degree? I looked into becoming a PT several times and all I heard about was how I’d need to re take a my prerequisites because they’ were taken so long despite the fact I have a BS (Healthcare Admin) and have been actively working as a PTA for more than 32 years. Maybe an undergrad degree as a PTA would have helped. However, if I had to do over, I would have pursued a career as a PT earlier in my career.
    Regardless, I love what I get to do everyday, and don’t really see myself retiring anytime soon.

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