Founder Letter: Why Rehab Therapy is at Risk of Losing its Workforce

We at WebPT have long preached the importance of placing patients at the center of the therapy experience; it’s also something that I discussed last month in relation to the early data from our PT Patient Experience Report. But, as crucial as the patient experience is, it’s only part of the picture when it comes to the overall health of rehab therapy. Therapists are doing the essential work of guiding patients in their recovery, and yet our latest research shows that they’re increasingly thinking of leaving their current roles as clinicians—or the rehab therapy industry altogether.

Our 2022 State of Rehab Therapy report is chock full of great insights, but there were some findings that stood out above the rest, with big, flashing lights—early warning signs for those of us that worry about the long-term stability of the industry. Employee turnover and burnout were two such areas of concern—not surprising given the strain of the pandemic on healthcare workers of all stripes. Per our data, the rehab therapy industry’s 2021 turnover rate average is roughly 9%, which is considerably higher than the current healthcare industry average of 3.7%. And while seeing the issues surrounding employee turnover is certainly concerning, these results also provide an opportunity to see where we’ve gone wrong as a profession in prioritizing retention and to fix the issues that survey respondents listed as their biggest concerns.  

Just how dissatisfied are rehab therapists? More than you may think. 

Many therapists may be anecdotally aware of the frustration and unhappiness felt by many of their colleagues, but the actual scope of the issue would probably catch many off guard. More than 70% of the therapists we surveyed stated that they were considering making some changes in their professional life, whether that be changes to hours, changes in roles, leaving their current clinic, or leaving health care entirely. Only 36% said they weren’t considering any professional changes—not exactly a testament to job satisfaction within the profession.  

Not surprisingly, the physical therapist segment was the one with the highest turnover in 2021, across organizations of all sizes. Equally unsurprising is the fact that managing employee happiness was the top-rated answer from clinic leaders as to the biggest challenges at their company. All of this begs the question: what has made rehab therapists so unhappy in their roles? 

Why are therapists looking for a professional change? 

As it so often is in rehab therapy, money is a major cause for consternation among rehab therapy professionals; in this instance, it’s salary concerns. Skilled providers, who are at the doctorate level, want to be compensated fairly for the important work they do, especially in light of the student loan burden that so many rehab therapists are carrying post-graduation; 25% of students in our survey were graduating with student loan debt between $100,000 and $150,000, and 15% are starting their careers with over $150,000 in student loan debt. To that point, the top reason therapists gave for considering a professional change was additional compensation, and we can’t underestimate the role student loans play in the practical need for therapists to seek higher paying positions and for employers to be more thoughtful in their total compensation packages. 

Student loan debt isn’t exclusive to just therapists working to pay back their education costs; an industry in which it isn’t financially viable to pay for your education and support yourself is one with a questionable long-term future. As Larry Benz, DPT, OCS, MBA, MAPP, President and CEO of Confluent Health points out, “The rippling impact of an overpriced, inefficient higher education system for PTs is wreaking havoc on new graduates, forcing them to need additional compensation during a time of unprecedented inflation when PT practices cannot raise prices in lockstep with higher costs or inflation.” 

Burnout threatens all of health care—not just rehab therapy. 

Burnout in health care isn’t a new concern but is escalating as a priority—so much so that the Surgeon General has sounded the alarm on the burnout crisis and what it could mean for the public health infrastructure as a whole. And rehab therapy certainly hasn’t been immune to the issue; 35% of all those we asked described themselves as “burned out.” The top reason given for this burnout across both providers and assistants was the high patient workload, with long working hours being the second-rated reason for therapists and third-rated reasons for assistants, respectively.  

It’s not hard to understand why the patient load is getting to therapists and assistants alike; according to our survey, therapists working at an inpatient hospital are seeing 20 patients a day on average, while outpatient therapists are seeing nearly 13 a day. And most respondents, regardless of setting, reported that their patient loads had either stayed the same or even increased over the past year, suggesting that the cracks are starting to show from the burden placed on therapists. 

Not enough leaders are addressing the problem. 

As Brian Gallagher, PT, Founder and CEO of MEG Business Management points out, “Employee retention is paramount to any private practice success. The number-one challenge we all face when owning a business is to assemble a group of people who share our common purpose and common goal.” So, given these systemic retention issues, you’d probably think that just about every clinic leader in the country would have taken steps to try to address the retention problem that’s hitting clinics everywhere.

Unfortunately, you’d be wrong; we found that nearly 28% of applicable respondents in our survey reported introducing no measures to improve retention or bring in new talent. Yes, you read that correctly—over one-quarter of clinic leaders opted to do nothing in the face of losing employees. Unless these are the lucky few clinics that have put in the work in the past and managed to avoid turnover entirely over the past year, it’s difficult to understand why so many have chosen to do nothing to prioritize employee retention, given that visit volume has returned to pre-pandemic numbers.

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The disconnect between clinic leaders and therapists is undermining our efforts

That lack of urgency in solving retention challenges speaks to a larger issue that we noticed in the survey results—a striking misalignment between therapists and leadership when it comes to why clinicians are considering career changes at a surprising rate. 

When clinic leaders were asked why therapists were resigning from their clinic, the number one answer given was that the therapist was relocating to a new city or state. The desire for a better salary was the third most common response, and the desire for a new challenge came in fourth. Notably, wanting a more flexible work schedule was only seventh on this list of reasons that employers cited for employees leaving. What makes these findings compelling is that they’re out of step with the answers their employees provided.     

Finding work-life balance is therapists’ top priority.

Therapists, on the other hand, listed work-life balance as the number-one factor they weigh when considering new job opportunities, with company culture second and salary third. Clearly, therapists today are taking into account more than just salary numbers when considering new jobs—or staying in their current ones. 

How can we bridge the gap between leadership and therapists to strengthen the profession?  

In the PT Patient Experience Report, we found that the biggest driver for patient-perceived success and the best tool for solving most of the issues between provider and patient was communication. And while we may not have a specific stat to back it up in the 2022 State of Rehab Therapy report, I feel it’s a safe bet that, now more than ever, better communication between leadership and providers would go a long way toward alleviating many of the issues we uncovered. And this report is, in part, therapists telling industry leaders what they’re really thinking and feeling about their roles; it’s up to us to take some of the most important points to implement them into our clinics. 

Let’s implement retention strategies that work.

Instead of assuming what employees want, let’s take a look at what they’re actually telling us in the report. Setting aside better compensation and new challenges, the top motivator for providers and assistants seeking professional change was greater schedule flexibility, followed by seeking career growth opportunities and feeling disconnected from colleagues or the company culture.  

You may have heard me talk or write about Daniel Pink’s book Drive and the three elements required to keep people motivated: autonomy, mastery, and purpose. Those elements are similar to the drivers that are pushing therapists to consider career changes, and validate that there is a lack of connection and motivation in the work they are doing.

Therapists in 2022 are looking for more than their counterparts were 10 or 20 years ago. Salary is important, of course, but there must be more. Therapists are rightly aware of the importance of maintaining time for their personal life in order to function at their peak professionally. As such, clinic leaders must offer career pathing and growth opportunities, as well as cultivate a culture that prioritizes its staff's well-being—especially if they intend to retain their top talent.

At first blush, you might think that it’s not possible to accommodate work-life balance while also maintaining clinic hours based on patients’ schedules. But I would argue that the lack of willingness in our profession to embrace telehealth and other technology as well as other evidence-based, value-additive changes in our care delivery is a disservice to our patients and our clinic professionals. We know patients want it, but only 47% of clinics are offering telehealth services based on our survey results. While it’s up to clinic leaders to give therapists the space to find that work-life balance, it's also critical that we as a profession remain relevant and embrace changes happening in health care at large inside the practice. 

Surveys can help you take the temperature of your team. 

If you’re wondering what your employees may want, it’s not hard to ask—and yet many clinics are missing their opportunity to do just that. Only 8% of employers surveyed made use of Net Promoter Score® or other employee engagement surveys to gauge how their team is feeling, and yet it’s a remarkably easy and effective way to gather insight. Not only is it going to give you the answers you need about what your staff wants, but it also demonstrates your desire to know how they feel and how you can help them remain satisfied and motivated in their jobs.  

Make technology adoption a cornerstone of your clinic.

Burnout and workload are major drivers of therapists’ desire to change roles or even careers, so why not do what we can to help relieve some of that strain with technology? 

There’s clearly an intersection of healthcare and technology that many therapists recognize as the future of rehab therapy; among those seeking a professional change,  the greatest number were looking at digital healthcare, technology, and innovation for their next professional challenge. Anecdotally, we had our highest number of physical therapists applying for jobs at WebPT this past year, demonstrating a growing interest in non-clinical roles. Many clinics are making use of at least some technology; over a third of respondents stated that their clinic used videoconferencing or virtual meeting software, and telehealth, patient engagement, and digital HEP software were all used by nearly a quarter of respondents.  

Technology offers an avenue for reducing your staff’s workload without eliminating the work or sacrificing revenue. In fact, streamlining the functions of your clinic with technology can reduce wasted time and effort to increase productivity and revenue. One of the biggest reasons offered by providers for burnout was the documentation and regulatory requirements—a hassle that the right EMR can help reduce. As a founder of an EMR company, this is a painful statistic, but we do take this information seriously and are prioritizing efficiency in our product development.  Digital patient intake, for example, can save your front office staff time, as can electronic benefit verification. A digital home exercise program, paired with remote therapeutic monitoring, allows your providers downtime from hands-on treatment while still providing billable services.    

All of us in the rehab therapy industry recognize how vital therapists and assistants are in the work we do, and recognize the particular strain that they’re under, especially after the last two-plus years. And while it’s not always easy to read the feedback we get in surveys like this, it’s so important to empathize with why they’re frustrated and burnt out so that we as leaders can do everything in our power to keep these gifted providers on our team and in our community. Because despite all the issues at play across our findings, over half of all respondents were as optimistic or more optimistic about the future of rehab therapy, which means that so many are able to see what our profession can achieve—if we put our efforts toward making it better for all involved.   

If you want more insights on our 2022 State of Rehab Therapy report, you can join me and our panelists TaVona Boggs, Larry Benz, and Keaton Ray for our webinar “The State of Rehab Therapy in 2022: Big League Insights for Long-Term Wins” on August 18 at 9 AM PDT.