In Celebration of World PT Day, It’s Time to Tackle the PT Awareness Problem in the US

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.

8 responses to “In Celebration of World PT Day, It’s Time to Tackle the PT Awareness Problem in the US

  1. Tim Mondale says:

    Heidi,
    I was with you right up until the build better relationships with physicians part. In my opinion, based on years of direct experience it is a near total waste of our time and energy resources to put this front and center. We’ve tried for years, and it is of little value. It’s an assumption that makes sense on paper, but doesn’t work in practice in any wholesale, and lasting way. It has always disappointed me, but has always been true (having nothing to do with holiday gift baskets). Direct to consumer, and legislatures (stopping at nothing short of full medicare direct access) is the road to follow, and it should be led by our national governing organization in a relentless manner.

  2. Cade D.C. says:

    Chiropractor here specializing clinically in corrective exercise… Do PT’s now have training in differential diagnosis? I was unaware that PT’s were able to function as primary care providers, and “peers” to physicians. I guess if PT’s do not have that knowledge and capability then a doctorate is completely unnecessary… so I’m sure they do now along with their DPT. Also, I want to be positive, but we can’t underestimate the impact of “easy, quick” treatment in the mind of the patient… and the fact that MD’s make more money for pharmaceutical companies and generate more money in general (compare price of surgery or long term pain med prescription- much more money coming into the healthcare facility through the MD route)… call me cynical, but I wonder how much progress can be made with patient laziness and corporate greed factored in… even if we do educate and network and market etc etc etc… Another thing- “accepting low ball reimbursement”… I know that the PT’s in my town are allowed by insurance companies to charge double or triple what I can for things like e-stim and exams etc… and I don’t feel that my rates are too low. I would like to keep them low, I don’t want to raise them just because “MD’s get to charge more than me and it’s not fair”. PT’s can get reimbursed $70 for e-stim and $200 for a routine initial exam (in my town)… how much do they “deserve” if that’s not enough? I think the solution is not charging more (that’s what led to the overinflation of the cost of healthcare in the first place), but fair treatment by insurance companies surely would help.

    1. Tim Mondale says:

      Cade,
      PT’s have for at least 30-40 years have been trained in differential diagnosis, and have had direct access in all 50 states, DC, and the US V.I. since 2015, and most states long before that. Note, this is all independent of the DPT (you don’t need a DPT to have direct access, only a PT degree…and a valid license of course).

  3. Hi Tim
    Thank you for the comment. I agree with you in terms of physician relationship building being of decreasing value overall. But you just can’t discount the power of a physician referral to a patient. If a patient says to go see Josephine Schmo, PT and she will take care of you, the majority of patients will follow orders. Now I agree that the tides are changing and more patients are becoming tech savvy and review influenced, so the direct to consumer marketing and legislative changes are a priority. I will also emphasize the importance of insurance company relationships as well. Data, data, data …. data and financial driven decision making is where the pendulum currently swings.
    But, we all need to make sure that what is “best” for the patient and putting patients’ health outcomes and well-being is at the crux of all of our decision making.

  4. Tim Mondale says:

    Thanks for your response Heidi. It is precisely your last statement that compels me to say we have to pass them on the right (Road travel reference), and move beyond what they (MD’s) obviously can’t, or aren’t interested in helping us with, in helping their patients in a safer and less expensive manner.
    We’ve waited far too long for that model, and our aches and pain population has suffered greatly as a result of our patient passive approach to self promotion. The “If we get them to like us and understand us then patients will understand and like us” philosophy has failed badly…it’s time to move on. We should act and promote ourselves like colleagues of our medical friends, not subordinates.

    Thanks for the discussion Heidi.

    1. Tim
      Would you mind sharing your techniques in marketing and other avenues to keep your schedule full and business growing? How are you attacking the 90%?

      1. Tim Mondale says:

        Heidi, for me it’s not about the small picture of keeping the schedule full, but rather getting as many people as possible to us as quickly as possible so we can help them. Full disclosure, I work for a hospital in outpatient care. Our problems are wait list’s and staffing. However I still want people that we can help more cheaply, and safely to get to us quickly. I want that done at the state and national level by the APTA with advertising and lobbying( mostly for direct access). If I had to I would hope I’d advertise locally, but with an unabashed, unrelenting message of best first choice, and results safer and cheaper. Part of my point and my problem with the whole notion of “educating” our medical colleagues is that I think it gets in the way of us aggressively branding ourselves to the public; as if we’re afraid to offend them or something.

  5. Brian P. D'Orazio says:

    Heidi,
    Thanks for the post. I’ve practiced for 40 years, with over 34 years in private ortho/sports. The following are my observations.
    1. Patients will see a DC before seeing a PT because they view the DC as the superior clinician. Much of this is because they can order imaging and there’s not any nonsense with referrals.
    2. PCP’s refer to PT’s only if there is a reciprocal relationship, but prefer to refer to their colleagues, especially orthopedists, and that’s where the PT referrals are lost. Very difficult to educate MD’s about PT. Mostly, they nod but probably don’t care what we’re saying. Also, they really don’t understand what we do or know and that needs to be addressed before they graduate. Not saying it’s a complete waste of time, but not a very productive use of our time.

    3. Insurance companies similarly are a big waste of our individual time. The APTA and the chapters need to build those relationships, but to date there has been little help from insurance. Since they are all publicly traded, they only care about one thing and we are not it. The less they can pay us the better. Frankly, the 2005 decision by CMS to change reimbursement to PT/PTA only reimbursement killed us…then they further cut reimbursement which is killing patient care. I haven’t seen anyone propose a meaningful solution to this and absent better payment, the profession is in grave danger.

    4. POPTS continues to kill the profession…just the way it is.

    5. If you haven’t walked into an inpatient rehab facility in a while, it’s shocking what passes for PT….and embarrassing. Really poor use of our education and it sends a horrible message to the public, medical providers at all levels and the insurance industry. Payment for services is so poor these facilities likely lose money on PT, so they minimize the service….relegating us to walking patients. I get it; it’s a paycheck with benefits, but horrible for the profession. I’m sure there is a PT out there reading this who has a wonderful situation at an inpatient rehab center…sorry that just isn’t the norm, as far as I can tell.

    6. We need to be able to do what we are trained to do; diagnose, order diagnostics, use diagnostic US when applicable, use our brains to delegate what we don’t have to do and be reimbursed for the complexity of what we do. Musculo-skeletal medicine is complex and as difficult as anything any MD is doing. The PT profession doesn’t always support this position because it separates some PT’s from others, but that is true among MD’s. Not everyone is a surgeon, yet every MD has an important role to play. So, if all you want to do is walk patients…fine, but that shouldn’t be paid on the same level as what we’re doing with pain patients. If we don’t diagnose, we aren’t valued. This is why DC’s ARE valued by patients.

    We can’t soar if we aren’t willing to take a harder look at our profession and create meaningful dialogue among ourselves. We have to stop being “PC” and call it like it is. Without adequate pay, we have nothing. If PA’s are going to be paid more than 50% more than we are paid, then it isn’t worth the financial risk to go to PT school and it isn’t worth the legal risk to treat patients. As long as CMS sees us as the enemy, we are in trouble. The looming risk of OIG investigations in our profession, coupled with the mountain of paperwork create a stress level that just isn’t worth it in the long run. What we do is so essential and personally fulfilling, but we have to stop believing in the same, worn out platitudes of making nice with everyone and it will all turn out fine. It hasn’t turned out fine in the past 40 years….at least not for many of us…and the same approach for the next 40 years will be equally nonproductive. So, while there is some small amount of truth to your treatise, by and large that approach has been and continues to be a failure. I’m sorry, but it just isn’t working in this country. The reasons for the failure can be debated, but why continue down the same path? We have said forever that if we could just produce enough research to show how effective we are then we’d be appreciated, but this has clearly shown itself to not be true. If we produced a piece of research that said we all get results of 100% in everything we do, we’d still be paid nothing and still wouldn’t be trusted by MD’s who trust themselves and their own practice patterns that include subordinating PT’s.

    Now, I don’t have the answers but I hope we stop pretending that the approach you suggest has been anything other than a failure for decades.

    Brian P. D’Orazio PT, DPT, MS, OCS

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