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May 12, 2020

If you have been reading these last few blogs, there is a good chance you are a physical therapist. At the very least, you are somehow incorporated into the world of healthcare. The final question posed for this series of blogs was:



What is the biggest problem that the profession of physical therapy currently faces?



Before answering this very loaded question, I want to first clarify that 1) this is only one man’s opinion, and 2) there is really no way to answer this using only one problem, so I hope you won’t mind if I ramble on a little bit about a couple of the pitfalls I foresee down the road in the future of healthcare, but more specifically in physical therapy.


For those of you who don’t already know, I host a podcast. It is titled “The Healthcare Education Transformation Podcast” (The HET Podcast). My co-hosts and I knew that healthcare education was a broken system, having all gone through it (albeit at different times and in different programs), but we were not completely sure how to fix it. So, we started getting experts in healthcare academia to come on and talk about their zones of genius, and then we end each episode with one final question...

“If you could change one aspect of higher education, whether it be DPT or otherwise, what aspect would you change, and how would you change it?”

The number one most common answer was COST. I am sure that is no surprise (and this is what led me to write my first book, PT Educator’s Student Debt Eliminator, as I myself was $140K in debt and had two doctoral degrees I wasn’t sure I really wanted to use, at least traditionally). This is definitely the first big problem we have.


The cost of PT school continues to rise at an astronomical rate, yet the salaries of even DPTs are starting out way too low, and what is worse-it generally tends to have a salary cap or a ceiling. There are only so many patients you can treat in a day, so there is a finite amount of revenue you can generate as a PT over the course of a year. Even if you are cranking out 20 or so patients per day at a “Mill” type therapy clinic, there is still only so much money that can be generated by one PT. 


So what can we do about that?


My solution to this is to get creative. Consider ways to generate revenue while you sleep, or during off hours of the day when you are not treating patients, or while you are treating patients but you do not need to be present to generate revenue. Can you write a book about your specialty or the population that you treat that could help them if they read it? Could you create an online program that would help a majority of your population before, during, or after their plan of care with you? Could you host a webinar or an informational workshop that could be recorded and reused for future potential clients that may be interested in your services? These are all ideas that should be considered to avoid having to see 20-30 patients per day and avoid burnout.




The next major problem I see affecting the world of physical therapy is “reimbursement levels”. Insurance companies in the mid 80s to early 90s were reimbursing physical therapists at fairly decent rates (at least at a level commensurate with what PT should be valued at).

That has been changing rapidly and reimbursement rates have been steadily declining to the point where insurance companies are almost looking at physical therapy as an expendable modality as opposed to a skilled treatment.

This is forcing many clinics to go the way of the “Mill” clinics and run high volumes of patients through their doors every day just to keep the lights on. Most of us in the field can agree that 20-30 patients per day is way too many patients for any one physical therapist to treat in a skilled fashion, not to mention the documentation that goes along with those patients. 


So how do we address this problem? I am perfectly fine saying I don’t know...which is why I pay my APTA dues annually and have done so for the last 15 or so years. I am not even the biggest fan of the APTA because I feel like it is a big ship that is very hard to move when it comes to changing direction, but they are the only ones on the front lines of Capitol Hill fighting for us, and I am fairly certain they are fighting the good fight. The actual amount of members as compared to PTs nationally is staggeringly small, and what is worse is the amount of money donated to the Political Action Committee (PAC)


When you compare it to the associations that support chiropractors and orthopedic doctors, physical therapists should almost be ashamed at the support we give our guiding association, but I digress. If we are going to fight the big bad insurance companies to reimburse us what we are worth, it is going to take the APTA's help and guidance. The only other option is that we begin going out of network for all insurances and lean towards a predominantly cash pay, out of pocket option where we can set our prices and the value that we feel we are worth (and that carries with it it's own set of unique difficulties).




Last but not least is the one problem the profession of physical therapy has been facing for decades now and that is our identity crisis.


Many people in the profession continue to say that the general public doesn’t know what we do. There are even other healthcare practitioners (doctors included) who have no idea what we do. You can call it a branding problem, you can call it an identity crisis, you can call it a general misconception of the profession. The bottom line is, I don’t look at this as a problem at all. I consider it an opportunity.  Why not just call yourself movement experts and problem solvers and go out and expand your reach and your horizon with how many people you can help and affect as a physical therapist?



The bottom line is, I don’t look at this as a problem at all. I consider it an opportunity.



It kind of goes back to the theme of these last few blogs: optionality. As a physical therapist…


I can treat patients in acute care settings, outpatient settings, skilled nursing facilities, pediatric clinics, and many more. 

I can also enter the world of academia and teach other students how to become proficient physical therapists. 

I can consult with major companies on how to prevent injuries from occurring to their employees.

 I can even work for a major league sports team and help get their athletes better. 


These are all completely viable options for a physical therapist to pursue as an occupation. But couldn’t I also help esports athletes prevent injuries and get stronger grips and better hand eye coordination via an ebook I wrote? Couldn’t I also help fantasy football fans become more well informed about injuries and return to play? Couldn’t I help other PT clinics get new patients in their doors through digital marketing?


The answer is YES! I know because I have done all of these things and my title is still Doctor of Physical Therapy. But I am not defined by my title. The title simply means that I went to school to further my knowledge in a health, wellness, and rehabilitation related field. What I choose to do with it is my "big picture".


I hope you will take the last problem/opportunity (depending on how you want to look at it) and allow it to change your perspective and open your mind to the endless possibilities that have been laid in front of you simply because you are a physical therapist!


-F. Scott Feil Pt, DPT, EdD


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