It’s Time to Overhaul PT Education: One Major Takeaway from the 2019 Graham Sessions

I’ve been attending the Graham Sessions for five consecutive years now, and each year, I return home more fiery and passionate about our industry—as well as the value we bring to our patients and our communities. Of course, this year was particularly special, because I had the honor of delivering a “What I Believe” speech—which, as I explained here, is basically the Graham Sessions equivalent of a TED Talk. In it, I discussed how we have the opportunity—nay, the responsibility—to seize the day, right now, to reach the 90% of people who could benefit from our care but aren’t yet receiving it. As I said during my speech, these are the patients who “have been left out in the cold to fend for themselves in a healthcare system that has been relentlessly pushing dangerous drugs and unnecessary procedures for far too long.”

With the entire nation focused on the opioid epidemic, this is our chance to step up to prevent millions of patients from going down a potentially perilous treatment path—and concurrently save our own profession from a similar fate. Yet, as I mentioned in my speech, even if we only reach another 10% of the patients who need us, that adds another 11 million patients to our collective patient load (approximately 335 patients per practice). To show up for these new patients—to provide them with the best possible care—we’ve got to make some foundational changes to support ourselves and our profession. Based on the dialogue that unfolded during the Sessions, one of those changes is overhauling the PT education system. (Given the high-profile—and highly outrageous—college admission scandal that recently came to light, it’s clear that the entire higher education system needs a serious overhaul, but for the purposes of this article, we’ll keep our focus on PT schools.)

We need more diversity.

The more patients we reach, the more diverse our overall patient population becomes, which means that we too must become more diverse. How else can we ensure that we are truly equipped to meet the needs of our patients? As it stands, our industry is anything but diverse. And that problem stems from our educational system—because PT programs have historically attracted people from overwhelmingly similar backgrounds.

We need PT schools to be more affordable—and accessible.

There are a lot of factors that contribute to the lack of PT student diversity, but the increasingly steep price tag on a DPT degree is certainly a big one—as noted by more than a few attendees of this year’s event. In fact, one attendee explained that “PT students represent 5% of all healthcare education students. But they hold 42% of all debt.” To put help put faces to that figure, several attendees revealed that they left school with anywhere from $100,000 to $400,000 in debt. And that aligns with we what learned from WebPT’s latest state of the industry report: “More than half of physical therapy students will have over $70,000 in student loan debt at graduation, and more than a third will owe over $100,000.” That’s physician-level debt without the physician-level salary to compensate for it. Based on the same survey data, we calculated that it will take the average DPT graduate 45 years to become debt free.

We need to keep the PTs we have.

And that’s a problem—one that’s not only preventing interested students from choosing this career path to begin with (many students, especially those who come from underserved and disadvantaged backgrounds, simply cannot afford to take on that amount of debt), but also burdening current PTs to the point that they’re contemplating bailing on the profession altogether. And can you blame them?

One young speaker shared that she didn’t feel the full effect of her student debt until she began working for a clinic that compensated her based on her billed units: “If a patient doesn’t show up, I don’t get paid,” she said. As I explained here, this type of compensation structure is a double-edged sword, because in addition to placing serious financial stress on therapists, it also disincentivizes them from spending unbillable time with their patients—even if that additional time could improve that patient’s therapeutic outcomes and care experience, both of which positively impact a practice’s reputation and ultimately, its revenue. Plus, being able to develop deep relationships with patients to better serve them is often the reason why many practicing PTs chose this profession and took on that much debt in the first place. (If you’re a practice owner or manager reading this right now, it’s never a good idea to have employee and company goals compete with each other—or with patient goals.)

These might seem like big problems to solve, but, as I said in my speech, “there are more than 200,000 physical therapists practicing in the US. That’s a force to be reckoned with—as long as we’re a force moving in the same direction.” And what are the Graham Sessions if not a forum to get some of the profession’s biggest personalities moving in a common direction? Here are three ways we can work together to move the needle on PT education and make it a better, more accessible industry—for future therapists as well as their patients:

1. Demand greater financial scrutiny for PT program accreditation.

During the Sessions, one attendee explained that, as it stands, “hundreds of millions of dollars” of student tuition never make it to the PT program that’s collecting it, which is why that attendee—as well as the APTA’s Private Practice Section—is urging all PTs to push the Commission on Accreditation in Physical Therapy Education (CAPTE) to require greater financial scrutiny for PT and PTA accredited programs. In other words, we need to demand that CAPTE do a better job of policing the allocation of tuition revenue to ensure that more of the money our students are spending is going directly to their education.

In fact, programs should be required to provide a clear financial breakdown in order to maintain accreditation. While the deadline to submit feedback to CAPTE on this matter has passed, you can still advocate for greater financial transparency and more responsible spending at the university level: consider reaching out to your alma mater to investigate how it is currently allocating tuition money.

2. Support alternative education models that reach a wider range of students.

The cost of higher education continues to skyrocket—and that’s especially true for DPT programs. While capping tuition costs would be ideal, it’s probably not very realistic to expect educational institutions to adopt such a policy. But there is another solution: we can continue to support alternative education models—ones that push the boundaries of what a physical therapy education should look like (and what it should cost). According to one attendee, “The game has already changed,” meaning that alternative educational models in the form of hybrid DPT programs are already providing students with more freedom and less debt—all by “cutting the fluff” and dropping the outdated notion that learning must take place in a brick-and-mortar environment. Instead, these new (and often expedited) programs are taking advantage of advancements in technology—and educational philosophy—to reach students who would otherwise be unable to enroll.

The popularity of these types of programs will continue to grow—especially as the cost to attend traditional DPT programs continues to rise. According to the above-quoted attendee, “The landscape of education is going to radically shift.” To that, I would add: it’s about damn time, because more students from diverse, underserved, and disadvantaged backgrounds will be able to join our ranks.

3. Implement debt-paydown benefits for staff PTs.

As PT leaders and employers, we’ve already paid our dues. So, some of us may assume that the next generation should pay theirs, too—whether that be in the form of working to the point of burnout or getting paid less than they’re worth. But I would argue that this type of “paying it forward” is not going to produce the results we want for our profession or our patients. Instead, let’s treat the next generation the way we want to be treated—and would have appreciated being treated when we first came into the profession. Now, that certainly doesn’t mean applauding entitlement, but it does mean helping our employees remove legitimate obstacles so they can focus more of their attention on being exceptional therapists. Isn’t that what being a good leader is all about?

To that end, consider implementing employee incentive programs that reward therapists with employer-sponsored contributions toward their student loan debt, because as one attendee noted (and I paraphrased here), “even putting $10,000 to $15,000 toward the principle of a loan now could exponentially reduce its overall cost”—not to mention relieve a significant amount of stress, mental overload, and worry. In addition to fostering employee engagement and loyalty—two very important things for personal and business success—instituting this type of program could also be a great way to encourage excellence in patient care. As I alluded to above, company success requires everyone’s goals to be pointing in the same direction: namely, putting people first.


If you’ve ever been to the Graham Sessions, then you know that the exceptional speakers and attendees wouldn’t possibly approach a problem as big as improving our industry and better serving our patients from just one perspective. Curious about the other ideas and suggestions that came up during this year’s meeting? Check out my full Graham Sessions 2019 recap here.




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.

One response to “It’s Time to Overhaul PT Education: One Major Takeaway from the 2019 Graham Sessions

  1. My name is Stacey Orozco. I am the CEO of an accredited vocational college in California. I would like to discuss this blog with you. Please contact me at 925-757-2900 at your earliest convenience. Thank you I look forward to hearing from you.

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