Coming Soon to an Inbox Near You: The State of Rehab Therapy in 2023

Although it might be hard to believe in today’s internet-driven, media-saturated environment, there was once a time when the previews you saw at the movies were worth their weight in gold. The coming attractions piqued our curiosity, causing kids (and some adults) to circle their calendars, eagerly anticipating a release date when all their questions would be answered. 

I like to think of the State of Rehab Therapy report as our summer blockbuster, and just like those eagerly anticipated franchise films, people are itching to see what the hottest topics and biggest issues are in our profession today. Our report isn’t about trying to sell tickets, though; we focus a wide lens on our industry to educate readers on the trends of the moment and to set the stage for how the plot will unfold in years to come.  

We’re still a couple of weeks away from our report’s big premiere, but we don’t want you to be stuck on the edge of your seat until then. So, in the spirit of that grand cinematic tradition, I’m offering a sneak peek of some of the most significant findings audiences can see in full when our report launches on July 20. And be sure to stick around through the end credits—we’ve got something special for you. 

Diversity efforts are starting to pay off. 

The lack of diversity within our profession has long been a problem. If we’re going to improve access to care and build stronger relationships with underserved communities, we need a more representative workforce. According to this study from the Urban Institute, diversifying the provider population could help address the mistrust in the healthcare system from people of color, who have historically faced mistreatment from white physicians. 

Fortunately, we’re seeing some positive movement in that direction in this year’s report, with modest gains among some of our underrepresented populations. The percentage of respondents who identified as white dropped from 77% to 70% this year, with some ethnic minority groups seeing increases as a result. And while it’s too early to declare victory, there’s reason to feel confident that we’re moving in the right direction.   

Students are slightly less burdened by debt—but feel more unprepared to graduate.

Student debt has similarly been at alarming levels for years, and it has only intensified with each successive report we've produced. However, we recently experienced a welcome shift in the right direction. The percentage of students projected to graduate with a staggering $70,000 or more in debt has significantly decreased from 56% last year to just 34% this year.  

The decrease in student debt levels could be attributed, at least in part, to a decline in applications to DPT programs. According to data collected by the Commission on Accreditation in Physical Therapy Education (CAPTE), the mean number of applicants to accredited programs has declined from 516 in 2015 to 346 in 2022. While we cannot draw definitive conclusions based solely on these numbers, it raises the question of whether the current cohort of PT students consists of individuals who are better equipped to afford DPT programs, resulting in reduced debt burdens. If true, this could inadvertently limit the opportunities for individuals from underrepresented or economically disadvantaged backgrounds who may face greater financial barriers to entry, potentially hampering the aforementioned progress we’ve made this past year in creating a more diverse and inclusive rehab therapy workforce.

Unfortunately, we haven’t witnessed a similar decline in students who feel unprepared for clinical practice. Across the board, students expressed a sense of unpreparedness in various aspects of their post-graduation lives (e.g., understanding Medicare compliance, using clinical technology, negotiating salary.) What’s even more concerning is that significant responses were received for each category, meaning there’s no silver bullet to addressing educational shortcomings.  

Burnout and turnover are only getting worse.

Burnout and turnover remain huge problems in rehab therapy (and healthcare at large), with no signs of going away anytime soon. The number of professionals who feel burnt out and the number leaving their jobs has increased from last year’s shocking levels. And it’s not a spoiler to say that burnout is tied to high patient loads, low salary, and burdensome documentation requirements—because that’s exactly what we saw last year as well. The same goes for turnover, where low salaries and lack of growth opportunities are once again driving clinicians to the exits. 

One interesting data point from the report is that women seem disproportionately affected by burnout and turnover; this year’s survey saw almost 12% fewer women in the overall makeup of the rehab therapy workforce. While the data collected didn’t make the reason for this clear, recent studies would back up the notion that additional household and childcare responsibilities drove greater burnout among women during and after the pandemic.    

Provider salaries are still stagnant. 

The salary section is always one of our report's most hotly anticipated parts, and it’s not hard to understand why. Clinicians are curious to see where they stack up compared to their peers and how pay is trending throughout the profession. Unfortunately, the findings this year will leave most readers disappointed. 

The percentage of providers earning more than $70,000 has dipped slightly from last year’s findings. While we could speculate that some of that dip may be due to respondents opting to take less pay in exchange for more free time or better benefits, the finding is generally in line with the prevailing wisdom that provider pay isn’t where it should be.   

Remote therapeutic monitoring is rising—and telehealth usage is way down.

Technology usage is always a point of interest for me with every year’s report, and this year’s findings were a mixed bag. The number of respondents using remote therapeutic monitoring (RTM) has ticked up to nearly 16%, and the amount of time spent on RTM and the number of use cases is similarly increasing. On the other hand, telehealth usage, which we expected to dip as the pandemic receded, instead took a steep fall from its previous levels.  

Fortunately, we can write our own ending.

If this were a movie, we could say that rehab therapy is going through some second-act trials. But as any moviegoer knows, protagonists ultimately overcome those ordeals and emerge stronger on the other side. I believe our profession is going through a period of change and that we’ll come out better for it—if we take a few lessons to heart.   

Continue supporting organizations that are driving diversity. 

Multiple organizations and institutions have been working to build a pipeline of more diverse students to create a more representative workforce. Schools have been putting intentionality into efforts to change the makeup of incoming classes for the past few years. The University of Alabama at Birmingham, for example, introduced diversity, equity, and inclusion (DEI) initiatives that raised the number of students from underrepresented areas from 9% in 2017 to 21% in 2021. Those initiatives included:   

• expanding recruiting efforts and scholarship opportunities for students of color, 
• introducing underrepresented groups to PT at an undergrad summer camp, and 
• building connections to health studies faculties at historically Black colleges and universities (HBCUs).  

Organizations like the National Association of Black Physical Therapy, the American Academy of Physical Therapy, the APTQI and Rizing Tide are also actively pushing to create a more diverse and inclusive rehab therapy community. In addition to creating a community for underrepresented ethnic populations, these organizations also provide scholarships, grants, and other forms of financial assistance to actively encourage individuals from diverse backgrounds to pursue careers in rehab therapy. And while the full impact of our student diversity efforts will continue to unfold over the next five years, we can certainly feel hopeful about these early results.

Make education more affordable—and more suited to help today’s students. 

It’s tough for me to speak directly to the challenges of students today; I didn’t have the same priorities and options when I graduated that today’s students do, and I thankfully didn’t have the same amount of student debt. But you don’t have to be a recent graduate to see that we can do more to help make education more affordable for students. Karen Juliano, PT, Senior Director of Education at HSS Rehabilitation, suggested that “An industry-wide focus on offering students resources on where to find scholarships or jobs that help with student debt or debt forgiveness could help students navigate their educational options. PT programs could also offer education and strategies on financial health and managing student loans that would benefit those entering the profession.” 

Building students’ confidence in their knowledge and skills might require educators to reexamine testing and curriculum to align it with the most up-to-date practices. It might also require changes to ensure that students get ample hands-on, practical experience in the skills they’ll need in their everyday work. As Rich Severin, PT, DPT, PhD, CCS, Owner at PTReviewer put it, “Addressing shortcomings in practical training must be a priority for the APTA, CAPTE, and ACAPT—especially considering the financial costs of DPT programs.” After all, if we’re going to meet the staffing challenges of the moment, it’s critical that future PTs are ready to step in and perform from day one.

Embrace new business models that provide new revenue streams—and offer clinicians greater control. 

In light of reduced rates from payers, adopting cash-based wellness services and improving patient marketing can be key to boosting revenue. These additional revenue streams can then be utilized to support higher staff salaries, creating a positive cycle of growth. Furthermore, introducing alternative compensation models that include base pay and performance bonuses can also give clinicians more autonomy over their hours and pay.     

Finding a way to pay skilled clinicians is a matter of survival for practices and our profession. As Meredith Castin, PT, DPT, Owner of The Non-Clinical PT, explained, “I believe as long as insurance reimbursement rates continue to decline, clinic owners will lose therapists—unless they dramatically change their business models to include adding wellness programs, selling equipment, or providing additional services onsite. Expecting clinicians to shoulder the burden of declining reimbursement is not a long-term solution.”

Create a workplace culture that listens to employees and shares their values.  

Two of the top motivators for those considering a career change were more growth opportunities and seeking an employer whose values align with their own. So if we want to get burnout and turnover under control, it will take open and honest communication between managers and staff, as well as retention strategies that value personal wellness and professional development. Retaining top talent will require practices to foster a culture that values personal wellbeing, introducing flexible compensation and scheduling options that allow staff to take time off as needed, and offering growth and career pathing opportunities.  

Adopt technology to reduce workloads and burnout. 

I can understand why some therapists have dropped telehealth and why there’s still some skepticism around RTM; we weren’t trained to use either as part of treating patients, and both seemingly fly in the face of our belief that in-person treatment is the best option. But telehealth and RTM can be valuable tools in patient care, particularly when we’re combatting burnout fueled partly by high in-person patient volumes.   

Think of telehealth as a more convenient way to follow up with patients on their HEP or to provide a home assessment, not as a replacement for in-person care. Patients certainly agree with that approach; according to a study published in 2021, 66% of patients preferred using some telehealth post-pandemic, even though the majority still preferred in-person care when choosing between the two.   

Similarly, RTM can augment your work, allowing you to monitor patients when they’re not in your clinic. It also gives you more touchpoints with patients throughout an episode of care—and as we know, greater engagement leads to better outcomes. Adding time for telehealth and RTM into your schedule gives clinicians a break from in-person treatment throughout the day. 

These insights are only a portion of what you can learn in this year’s State of Rehab Therapy report. The full report features more data and more industry leaders offering their thoughts on some of these issues and how we can start to address them. 

Can’t wait to dig in? Well, you’re in luck; as a new wrinkle for this year’s report, you can sign up for our waitlist to get a copy emailed to you as soon as it’s available. Just fill out the form below and watch your email on July 20. 

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