Taking Control of OUR Future (Part 1)

Today’s guest article comes from Kim Rondina, PT at www.wisdomptcoach.com — covering perspectives of our profession’s future in a multi-part series. Here’s Part One!

First, let’s establish our purpose with the upcoming series….

As a clinician of 18 years and one that has experienced many aspects of our profession as an employee, clinician, owner, mentor, and influencer, I feel it critical to lead a conversation focusing on our therapists.

This requires self-reflection and emotional intelligence in navigating the history, the present and the future. And establish the mindset that will re-define our opportunities as therapists by being open, curious and solution oriented.

Part 1 – Sources of Our Pain

Along the course of our careers as physical therapists it’s inevitable that we will seek greater levels of autonomy. Exploring both our relationship with the demands of our profession and with our expectations is crucial to creating sustainable success and taking control of our future.

A mentor of mine once told me to get the attention of physical therapists, especially leaders you have to appeal to their pain! My experience has proven her recommendation correct many times over. So that’s where we’re going to start, as uncomfortable as that may be for some.

Sources of Our Pain…Within Our Practices

Working with hundreds of owners, leaders, and therapists a few common themes arise and they’re what I call the 4 R’s….

The top 4 challenges for physical therapy practices:

Reimbursement

Referrals

Retention

Recruiting

The first two R’s represent the recurring issues that have plagued our profession for decades. Strict cost containment programs driven by insurance carriers have led to contract rates that challenge even the most operationally efficient organizations. And despite a variety of efforts, our ability to connect with our referral sources the message just isn’t translating. An article published by Freburger in June 2018 Journal of General Internal Medicine found that from 2003-2014, primary care referrals to physical therapy for musculoskeletal injuries dropped by 50% from 94.4 to 42.9 per 1000 visits. During the same time, referrals to physician specialists increased. Are we really being seen as a valuable part of the healthcare community?

The last 2 R’s focus more on the inside, and that being our teams of therapists. Turnover is a hot topic but let’s throw in some information to help us get a sense of where we are headed. With respect to:

Retention

Student debt exploding to 6 figures (WebPT), resulting in job hopping for financial gain.
91% of millennials expect to stay at a job 3 years or less (Ganapathy).
A study from 2016-7 PTs saw the highest increase in percentage of turnover amongst allied healthcare professions (2018 National Health Care Retention).

Recruiting

PT is the 2nd most difficult job to fill (American Staffing Association).
According to the APTA, there is an expected shortage b/t 10-26K therapists in the next 5 years.
12 states currently have shortages; 48 of the 50 states are expected to have shortages by 2030 (Zimbelman).

Sources of Our Pain – Industry

Let’s get an even bigger picture of the sources of our pain …..shifting to where has our industry been in the last decade. Want to preface this dialogue by stating that I strongly value each of these issues and the effort that has been forth to execute them. My reflection here is merely meant to facilitate curiosity about our CAPACITY to see what really creates a successful future for our profession and our practices

Direct Access

Since 2014 all 50 states have had some form, yet only 8% of those pts dx’d with a MSK injury seek PT so it begs the question is access the issue?

Vision 2020

Although its intention was to elevate our profession, it may have been a bit shortsighted in defining our reach as therapists. The fact that a modified version was later adopted reflects that:

Professional division resulted as the initial language made non-PT providers somehow less than. The scope also de-valued niche providers (pelvic health, CrossFit), and let to judgement based off of environment you work in (private practice/hospital/SNF/mobile/home health). Further example of that division may also contribute to only 30% of therapists being members of the APTA as a show of support for their position in representing all therapy providers.

Entry level doctorate

There are three groups in which I believe this advanced degree was intended to influence: First being 3rd party payers. Ironically since the DPT was implemented reimbursement has only continued to declined and we are now more of a commodity than ever. Are we falling into the same mindset trap and believing the DPT is not enough? Growth of residencies and fellowships suggest we are still seeking approval and value as a profession and not just from within.

The second group are our referral sources. We can simply refer to prior comments on direct access and PCP referral rate as to how this relationship just isn’t creating results for therapy providers and the community they can serve. Speaking of the community, they are the third and final group. Numerous studies show we have a branding issue. People simply don’t know what we do our how we can help.

All the while, the fitness/wellness, health coach and alternative medical industries have all blossomed so our target is willing to engage. Are we focused on the wrong message?

Outcomes

Looking forward to a forth area that our profession is currently focused on is outcomes data. My question is this opportunity going to fall prey to the same misconceptions about its potential impact? Time will tell.

Each of the 4R’s as well as the industry-based sources of pain represent a scarcity mindset, in which ‘not enough’ will always be present. The true opportunity exists in seeing opportunities within. Part 2 of Taking Control of Our Future will address the internal reflections that we each individually need to undertake as well as identifying our true stakeholder that will have the greatest impact on our fulfillment as physical therapists.

References:

Freburger, J.K., Khoja, S. & Carey, T.S. Primary Care Physician Referral to Physical Therapy for Musculoskeletal Conditions, 2003–2014. J GEN INTERN MED (2018) 33: 801. https://doi.org/10.1007/s11606-018-4426-6

WebPT. (2018). The 2018 Rehab Therapy Salary Report. Retrieved from: https://www.webpt.com/resources/download/the-2018-rehab-therapy-salary-report

Ganapathy S. (2016, Sept 1). 10 Millennial Personality Traits that HR Managers Can’t Ignore. Retrieved from https://www.mindtickle.com/blog/10-millennial-personality-traits-hr-managers-cant-ignore/

NSI Nursing Solutions, Inc., (March 2018). 2018 National Health Care Retention & RN Staffing Report. Retrieved from http://www.nsinursingsolutions.com/files/assets/library/retention-institute/nationalhealthcarernretentionreport2018.pdf

American Staffing Association. (2014, Oct 15). ASA Skills Gap Index Introduced to Track Trends in Hardest-to-Fill Jobs. Retrieved from: https://americanstaffing.net/posts/2014/10/15/asa-skills-gap-index-introduced-track-hardest-fill-job-trends/

American Physical Therapy Association. (2017, April 17). A Model to Project the Supply and Demand of Physical Therapists 2010-2025. Retrieved from: https://www.apta.org/WorkforceData/ModelDescriptionFigures/

Zimbelman, J.L., Juraschek, S.P., Zhang X., Vernon Lin, V.W.H. Physical Therapy Workforce in the United States: Forecasting Nationwide Shortages. PM R 2010;2:1021-1029 http://healthcarousel.ph/wp-content/uploads/2014/08/PT-Shortage-2010-Zimbelman-Et-Al-Article.pdf