PT Perspectives: What Clinicians Are Saying About the Lasting Legacy of COVID-19

On March 11, 2020, the World Health Organization declared the COVID-19 outbreak a global pandemic. Since then, every industry has grappled with how to do business and provide services to their clients, constituents, and patients—and the therapy world is no exception.

According to an APTA report from August 2020, almost half of clinic owners closed their doors at some point in the early months of the pandemic. Most reported closing as a result of exercising professional judgement, while others cited patient cancellations, state mandates, and a lack of personal protective equipment (PPE). A large majority of clinic owners reported revenue losses. PTs and PTAs faced reduced hours and income as they navigated a wholly new way of providing services: telehealth visits.

Here we are one year later, and while we aren’t out of the woods by any stretch, we’ve seen encouraging signs that things are moving in a positive direction:

• As vaccinations increase and case numbers trend downward, many clinics are returning to prior caseload volumes.
• Those seeking in-person physical therapy services appear more comfortable and confident in doing so.
• Clinicians have embraced health and safety measures to slow the spread of the virus and lower the risk of exposure in both outpatient and inpatient settings.

To get a better idea of how things are developing on the ground level, I recently chatted with a few California-based physical therapists about how this past year has shaped each of their practices, what changes they believe are on the horizon, and more. Here’s what they had to say:

Babken Sarkissian, PT, DPT

CEO and Owner, Revamp Physical Therapy & Fitness

You opened a brand-new clinic in October 2020, during the heat of the pandemic. How has your experience been so far?

Well, we are still calling it a “soft open.” I’ve been planning to open this clinic for a couple of years now, and the timing of the opening just happened to coincide with being in a pandemic. We are now close to being fully booked with therapy appointments, but they are all one-on-one sessions. We’ve also been offering family training sessions, allowing people in the same “bubble” to work out together.

Did you have plans for your opening that you were unable to carry out due to COVID?

We had planned to build more buzz in the community and to offer group sessions and exercise classes, but that all went out the window.

How are your patients’ comfort levels with receiving in-person care in the clinic?

The comfort levels vary widely. A lot of people don’t enjoy working out with a mask on, but it’s our policy. We want people to be comfortable, but we also want them to be safe, and for other people to feel safe there as well.

What’s one thing that you suspect may never go back to the way it was before?

Honestly, I’ve been in some clinics that aren’t the cleanest. I think the move toward cleaning more frequently, having hand sanitizer available, and even requiring masks may stick around. I think even post-pandemic, I will keep wearing masks when I’m working closely with patients—it just feels more hygienic for both parties.

What plans do you have once things get closer to “normal?”

I plan to offer more group classes as well as focus more on marketing to the community.

Kristen Lopez, PT, DPT

Director of Physical Therapy, Longevity Physical Therapy, Bressi Ranch Clinic

Your clinic closed down at the beginning of the pandemic and then slowly reopened. That must have been quite a rollercoaster, right?

Yeah, we closed down fully for two weeks—and that was actually more work than seeing patients. Once we decided to carefully and slowly reopen, we had to figure out how to navigate seeing our most essential patients in-person, what telehealth would look like (and how to bill for it), how to fill our staff’s schedules, and countless other issues.

How have your operations evolved since then?

As the weeks went on, we started opening up our PTs’ schedules a few hours a day to any patients who felt comfortable coming in. Of course, we had to develop new screening procedures and restructure the layout of the clinic to maintain social distancing.

Are you back to pre-pandemic patient loads?

Our PTs have been back full-time since August, but our clinic isn’t as full, because we have shifted to solely one-on-one visits with no therapy aides. We overlap patients as little as possible. We also still have a small handful of telehealth visits, about two to three per week.

What do you see changing—and not changing—as the world slowly returns to normal?

I think we are learning a lot about how this virus spreads, and while we were furiously cleaning every single surface in the beginning months of the pandemic, I think the more we learn about the lower risk of transmission from surfaces, the less we will be so concerned with that aspect. I do see us keeping our one-on-one visit format going forward; our patients seem to really enjoy that.

Jared Leeper, PT, DPT

Full-time physical therapist at a trauma center in South Los Angeles; per diem at several other locations (including community hospitals, a skilled nursing facility [SNF], and an acute rehabilitation unit [ARU])

How has the past year impacted you and your organization(s)?

In the hospital setting, we saw a decrease in elective surgeries, which resulted in a loss of hours as we geared up to address those affected by the pandemic. Most periods that required flexing off occurred in the lulls between surges, and for the most part, staff were able to continue providing services while maintaining expected hours. My experience is variable, as I started several per diem jobs right before the pandemic began. While I observed furloughs for rehab staff in the ARU and SNF settings, diversifying my time by being available to multiple settings allowed me to actually have a more successful financial year.

How did you and your colleagues cope with seeing patients affected by COVID?

I have been grateful to be around others that have a shared sense of duty to the patients as well as each other. I’ve found this not unique to PTs or to my setting (as I have worked in three different hospitals, two SNFs, and one ARU this last year), and I feel very fortunate in that sense.

How have you seen COVID-19 impact patient care?

The biggest issue with patient care that quickly became obvious is the loss of immediate access to visiting family. I believe we treat the whole family to maximize quality of life for all. Not having family available for all patients was difficult (though somewhat remedied by a phone call). For patients with cognitive issues, family can often be our bedrock to keep the patient grounded, and this was a huge loss.

For patients affected by COVID, our entire treatment model shifted. There was no guidebook. And especially for those with COVID, the family restrictions also highlighted the importance of human time. We have all read about the concept of “healing touch,” and it’s easy to forget about the basic need for human interaction. Some sessions felt more about human dignity and just sharing time, rather than trying to enhance gait and quality of sit to stand. The use of physical touch during sessions to assist mobility really highlighted how intimate our role in health care is.

What is a change you’ve made that you believe will continue post-pandemic?

The pandemic has completely changed the way I used to “cookie cutter” interview patients. I’ve also had to become more flexible due to lack of ability to educate family members in the flesh.

What changes do you anticipate as things get back to “normal?”

This is the first year in my five years as a PT I haven’t gotten sick. Not even a sniffle or sore throat! I will probably continue to wear surgical masks—even while I continue to get yearly vaccinations for influenza (and COVID if it becomes an annual thing—please no!).

How has this past year shaped you?

I think that for me, I just put my head down and charged ahead over the last year to be my best husband and PT self. Only in the last few weeks, as I’ve had time to reflect on a year in the heart of the pandemic in South Los Angeles, have I truly felt overwhelmed by all I saw and was involved in. I always said when things went south, it was the doctors and nurses who came and did the heavy lifting. I now feel the weight of 2020—the fear and loneliness of patients. It even makes me emotional to compose those words.

The events of the past year have affected every one of us in a unique and lasting way. We have collectively grieved the loss of normalcy as we once knew it. Therapists working in outpatient settings may have experienced a loss in income or uncertainties about the future. Those in inpatient settings likely witnessed many tragedies—but also some joyous moments of rehabilitation and recovery. As we look to the future with cautious optimism, hoping the darkest days are behind us, may we carry forward the changes of the past year that best serve our communities—and not forget the lessons of this most consequential year.