September 8 is World PT Day—a day that was established to celebrate and bring awareness to our awesome profession across the globe. In case I haven’t made my love for the physical therapy industry abundantly clear up to this point, let me take this opportunity to do so. I wholeheartedly, whole-bodily believe in the power of what we do—and its impact on not only our patients, but also their family members, coworkers, friends, and communities. After all, improving the life of one person ripples out to improve the lives of many—and we most certainly do improve lives. In fact, we’re able to help many of our patients achieve better outcomes at a lower cost point compared to other, more invasive interventions. And I believe the tides are beginning to turn in that more patients, non-PT providers, payers, and policymakers are starting to recognize the tremendous benefit of physical therapy and its potential to improve health on a global level.
We have a bright future.
The damaging effects of the opioid epidemic are coming to light in a big way, and that’s a huge opportunity for us to own our value—and effectively communicate it—and thus, help those patients who have not yet received the care they need to experience improved function and movement (without the risk of drug dependence). It’s also an incredible opportunity for us to get to those patients who are experiencing a functional deficit first—before they ever go down the pain medication path. When I look toward our future, that’s what I see: an entire industry of doctorate-level providers who are not only incredibly well-equipped to help the world, but also so confident in our own abilities that we stop practicing in physicians’ shadows and accepting low-ball reimbursement rates—and start truly educating the world about the value we have to offer.
But, we still have an awareness problem we must overcome.
To get there, though—to reach that future—we need to make an honest assessment of where we’re at right now. And frankly, we have some work to do. After all, only a small percentage of people in the US (about 10%) who could benefit from receiving our services ever do. And I don’t think that’s due to an access problem; I don’t think patients are making an educated choice to select other care channels. Instead, I believe it’s due to an awareness problem. Patients, providers, and payers are still overwhelmingly unclear about what we do and why we do it, so it’s no wonder they’re leaning toward treatments that appear easier or faster. And no one is going to be able to remedy that misconception but us.
Physiotherapists have a different reputation.
Now, it’s interesting to compare physical therapy in the US to physiotherapy in other countries—the United Kingdom (UK), for example. Anecdotally speaking, physios in the UK seem to be more highly respected by the average consumer than physical therapists in the states. And access to—and awareness of—physiotherapy seems to be more of a trend abroad. There are several factors that may contribute to that trend, including that (1) the industry has been around a little longer in the UK than in the states, and (2) patient access to physiotherapy has improved (especially for non-specific lower back pain) as a result of the UK’s National Health Services (NHS). Or, perhaps there’s something our UK peers are actively doing to improve their reputation as physiological experts. Regardless of how things came to be this way, it’s clear that we may have to sell ourselves a little more robustly to overcome our prior positioning as ancillary healthcare providers in the states. (If any UK-based therapists are reading this, I’d love your input in the comment section below!)
However, that doesn’t mean they aren’t undervalued.
All of that being said, when I typed “Why are physios…” into Google, it auto-filled with “paid so poorly?” So, perhaps we’re being undervalued across the board. Still, based on what I gathered from my research, physiotherapists are eligible to practice after three years of undergraduate study in the UK. Compare that to the seven years it takes a US PT to complete undergraduate and graduate degrees. That means we’re leaving school with an advanced degree—and, in many cases, overwhelming debt that is incredibly disproportionate to our starting salaries. Sure, we could spend this time complaining about the broken system that’s causing many would-be physical therapists to shy away from pursuing this career in the first place. Or, we can take this time to talk about the things we can do to improve our positioning, earn more money, command the respect that we rightfully deserve as first-line healthcare providers, and reach the patients who need our services now (and that goes regardless of geographic location).
There are patients who need our help but aren’t receiving it.
After all, it’s crucial that we figure out how to overcome our awareness problem sooner rather than later, not only for our own financial solvency, but also for the patients who are suffering from musculoskeletal pain and desperately need a less-risky alternative like PT. We won’t be able to reach them if they—or their physicians—don’t know what we have to offer. And according to a study published in the Journal of General Internal Medicine, primary care physician referrals to physical therapists for musculoskeletal conditions have decreased by 50% between 2003 and 2014, despite the emergence of data promoting PT as a first-line intervention. That means, as I mentioned above, that the onus to solve this awareness problem is on us; physicians aren’t going to do it, and neither will patients—at least not without our help.
It’s up to us to remove the barriers to access.
So, here’s how we can work together to remove the barriers that are currently preventing patients from accessing PT:
- Work with (rather than against) insurance companies to provide them with the data necessary to improve coverage of—and access to—PT. In our recent industry survey, insurance requirements topped the list of barriers preventing PTs from reaching patients before they see a physician—and government regulations and high patient copays and deductibles were the top two barriers to providing effective care. I know it’s easy to think of the big, bad insurance companies as the enemy. But, railing against them is not going to get us the results we need. Instead, we need to partner with them to educate them and provide them with the data they need to push pro-PT measures through to enactment.
- Leverage direct access to its full potential—and focus marketing efforts on consumer-facing initiatives. Whether or not you practice in a state that allows unrestricted direct access to physical therapy services, there are still immense benefits in taking advantage of the ability to, at minimum, perform an initial evaluation on a patient before he or she sees a physician. It’s a huge opportunity for us to position ourselves as primary care providers for patients with neuromusculoskeletal issues and establish ourselves as peers to other doctorate-level medical professionals. It’s better for us—and so much better for our patients, especially those who might otherwise end up on pain medication.
- Build better relationships with physicians. Ditch the goody baskets and build your relationships with physicians based on the benefits those relationships provide to your combined patient base. In other words, don’t position yourself as an ancillary provider who’s only interested in a transactional relationship that gets you more referrals. Instead, get to know the physicians in your area, learn about their—as well as their patients’—pain points, and determine how you can provide value, overcome objections, and educate about the objective data-backed benefits of a PT-first treatment route.
We need data.
Changing the culture surrounding physical therapy in the states is going to require a concerted effort from all of us—as well as data. But not just any data: Real, objective, researched data—the kind that payers, physicians, legislators, and patients can’t ignore. Then, we need to communicate that data in a way that resonates with each individual entity that influences our success—to help payers, physicians, legislators, and patients understand exactly what that data means for them.
I have the honor of speaking about the continued importance of data in the PT industry at the World Congress of Physical Therapy in May. I hope events like that—and discussions like this—help inspire physical therapists in the US to think differently about their place in the overall healthcare continuum. After all, we’re not ancillary providers anymore—and we certainly don’t have to keep acting like we are.
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.