To Make Our Profession Whole, We Must Mend Its Broken Parts (as Told at the 2022 Graham Sessions)

As a seven-time Graham Sessions attendee, I’ve come to expect the educational and thought-provoking discourse this event has become synonymous for—and this year, I wasn’t disappointed. The sessions covered a wide variety of topics that are top of mind for both experienced and incoming PTs and PTAs. I was pleasantly surprised by the diverse mix of first-time attendees, PTs from many specialties, and fresh PTs as well as us veterans.  From career satisfaction and meeting new-PT expectations to our DPT programs and the APTA House of Delegates, the Graham panelists didn’t leave many stones unturned.

As these discussions progressed over the course of the two-day conference, a theme began to emerge: Physical therapy as a newer profession still lacks clear direction and a cohesive brand under which we all can unite. As we know, physical therapy encompasses countless specialties, practice types, and clinical settings. And each has its own unique wants, needs, and problems to fix. What’s more, each of these entities has its own goals—and many serve different purposes and patient populations. So, to say our profession lacks direction and cohesion shouldn’t come as a surprise to many PT professionals.

While it’s easy to create a list of our flaws (as evidenced just now), I’d like to reframe the focus of this Graham Sessions recap to discuss how we can take steps toward repairing our faulty parts—those which impact our entire industry—and help create a more unified future for our profession.

There’s a major disconnect between new PT expectations and reality.

Coming into the profession today is much different than it was 20 or 30 years ago. Not only have the educational requirements and costs changed, but our industry has faced its fair share of payment cuts and regulatory changes that have, in turn, drastically altered the climate of our profession. This has created a substantial generational rift between seasoned and new PTs, causing a misalignment of expectations and values.

While I can’t prove how this rift is directly impacting PT career satisfaction now, I do feel like it’s a major factor in new PTs’ growing discontentment in our profession. And if this divide continues to expand, it could be a tremendous blow to our industry’s ability to attract a wider variety of prospective PTs—and grow our profession for years to come. 

While there’s a likely a number of reasons that contribute to distorted career expectations, the main perpetrator seems to lie with our industry’s educational institutions.

We must innovate our DPT program models.

Helping people is the main reason we all chose this career path. Our educational institutions have primarily focused on the academic and clinical view of the PT—from tried-and-true gold standards to research methodology. These are all important pieces, however, our DPT programs don’t even come close to providing students with the tools and resources required to understand the realities of being a PT—and particularly, the business side of our industry. 

Without this knowledge, new PTs have a hard time wrapping their heads around things like the true relationship between clinic revenue and individual paychecks or shifting compliance regulations (and how these impact PT practice). Developing an understanding of the business side of physical therapy can not only help provide PTs realize their own market value but also recognize which levers to pull to push for more innovative approaches in the patient experience. 

This institutional shortcoming is only compounded by the massive amounts of debt today’s students are incurring to become a DPT. According to our 2021 State of Rehab Therapy report, the segment of students who will owe more than $150,000 upon graduation has grown about 5% since 2018. That’s absurd—especially when considering the national annual salary average for an entry-level PT is currently $77,874. It’s no wonder student debt has consistently ranked in our report as the number one fear that students have when entering the profession—not to mention being the number one reason that students of color drop out of PT programs. 

The Solution

There are a lot of things that need to change on the educational side of our industry to mirror its reality. However, what we can focus on now is shortening the academic components of these programs—and the time in PT school overall—and adding more clinical and business experience to the curriculum. This will help to do two things:

• Minimize student debt; and
• Increase students’ awareness of what today’s therapists encounter in practice.

Change and innovation are already starting to occur, however, in order to meet the demands of society and the healthcare needs in this country, pushing to accelerate the pace of change is critical.  

Burnout isn’t outside of our control—yet.

This generational divide has added considerable fuel to one of the greatest epidemics of our age: burnout. At this year’s Graham Sessions, there was a lot of discussion about whether burnout exists or not. Those on one end thought there is no such thing as burning out if you have a true passion for what you’re doing. Those on the other side felt that by making the claim burnout doesn’t exist, you are ignoring the data. Though, both sides agreed that the label “burnout” has become a catch-all term that needs further detail in fully understanding the scope of the issue.

Personally, I do believe burnout exists—and that specific signs and symptoms attached to it have been exacerbated post-pandemic. Our industry report actually found that roughly half of the therapy professionals surveyed stated they felt more “burned out” now than they did pre-pandemic. And yet, the majority of our respondents also indicated they have no desire to make any career changes.

What this tells us is:

• Rehab therapists still believe in our profession, despite its flaws; and
• Clinic leaders must work to address burnout while therapists are still invested in the profession.

We must seek to better understand burnout as it exists in our own clinics.

Just as PTs’ expectations have shifted over the past couple of decades, so, too, have their professional wants and needs. So, the best way to fight burnout in your clinic is to open up the lines of communication between you and your therapists and create a workplace culture that prioritizes transparency and trust. Seek to understand how to best support your team—and then take the necessary actions to do so. 

Creating an environment in which the staff feels comfortable in talking to their leaders about issues that may be affecting their ability to provide the best care to their patients is critical. This safe space also should include conversations to help determine what your therapists’ goals and motivations are. Connecting with your team as fully formed adults with dreams, passions, and excitements can help empower your therapists to reach their full potential.

Regardless of whether you think burnout is a social construct or a real epidemic, the main takeaway here is that part of your role as a clinical leader is to make your team feel heard, validated, and empowered. No one wants to be treated like a commodity.

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Promoting PT’s value isn’t going to happen on its own. 

The topic of leadership also came up a great deal at this year’s Graham Sessions, and primarily, what it means to be a good leader in this industry. The main takeaway was this: Practice size, location, or setting, doesn’t dictate whether a PT is capable of leadership. Rather, leadership is defined by the effort PTs are putting forth in getting great clinical outcomes and influencing those in their own professional circles. Leadership doesn’t have to mean managing a large group, rather it’s about the individual impact each of us can make to collectively strengthen our industry’s voice and promote its value within the greater healthcare continuum.

We must all hold ourselves to a higher standard.

Although there are a number of ways each therapist can lead the charge in promoting PT’s value in their own practice, I think each of these dovetails into a single critical mantra: We must hold ourselves—and our services—to a higher standard. So, here’s what I propose we prioritize:

• Practice to the full extent of your license: As medical professionals, we have a unique set of skills to promote health and wellness within our population—skills that no other medical professional has. So let’s prove it! Use data and objective results to craft the right messaging that shows your value to patient care, and will empower other healthcare professionals to be our allies.
• Leverage data to secure fair payer contracts: We are beyond the days of accepting crappy contracts that undermine our value. So, we must use data to show payers how a PT-first approach to care works—and the impact it can have on downstream costs for all healthcare stakeholders (insurers included). This will greatly increase your chances of securing fair contracts and demonstrating our industry’s worth to the masses.
• Make PT a covered benefit in your clinic: If you’re truly committed to promoting the value of our services, and convincing other healthcare professionals of the power of PT, you must demand to have PT as a paid benefit in your insurance plan. Period.
• Endorse the next generation of leaders: I strongly believe that the best way to cultivate long-term success for our industry is to nurture your passion for it—and to nurture others’ passion, as well. Set time aside to meet with and mentor those who are just coming up in their career, and show them what being a great PT really means.

There are others trying to displace us.

There are always going to be competitors in our line of business, and digital health companies are no exception. In fact, the digital health market closed the first quarter of 2021 with $6.7B in US funding, becoming the most-funded quarter in history. And some of these startups, like Hinge Health and Sword Health, have carved out a considerable niche for themselves in the employer space. This is largely due to their ability to provide patients and employers with convenient healthcare solutions—something that PT has historically struggled with it.

We must learn from digital health startups.

There’s no point denying it: Digital health is here to stay. It’s up to us now to determine how we’re going to get ahead of this trend in order to bolster our profession in the long term. My answer? Focus on the convenience factor. And specifically, embrace technology in your own clinical spaces to augment your hands-on care by offering:

• Telehealth and virtual care;
• HEP apps;
• Online scheduling and payment portals;
• Digital patient intake options, and
• Digital review options. 

As one of the Graham Session attendees stated, “Those that can imagine their job as being very different are going to be the ones who are going to survive—and thrive.” To her point, we need to continue to evolve as a profession. Adopting digital solutions can help us better connect with our patients, improve their experience, and expand our clinical reach. In turn, this can help us work toward PT’s persistent 90% problem and establish our position as the preeminent musculoskeletal providers in the healthcare space—regardless of who our competitors may be.

There is still a lot of work to be done to diversify our profession.

At this point, it shouldn’t come as a surprise to hear that our profession has a diversity issue. According to WebPT’s aforementioned industry report, roughly 77.4% of rehab therapists are white. By contrast, 6% of rehab therapy professionals are Asian, 5.2% are Hispanic or Latino, and 2.8% are Black. These numbers do not mirror the demographics of the US population and the patients that we see in our practices. As physical therapists, it’s crucial for us to understand how this disparity impacts our ability to reach a wider, more diverse, group of patients who could really benefit from our care. After all, according to this article from St. George’s University, “when a patient cannot find providers that resemble them, their beliefs, their culture, or other facets of their life, it may delay or prevent them from seeking care.”

We must keep the DEI conversations going.

It has been heartening to see recent efforts that have been made to improve diversity, equity, and inclusion (DEI) in our industry, like:

• APTA’s renewed initiatives to attract non-white students into PT,
• Rehab therapy companies' participation in the CEO Action coalition, 
• Industry conferences hosting more sessions dedicated to DEI, and
• The emergence of scholarship organizations that encourage diversity and inclusion.

And while I believe we’re starting to turn the corner on this front, breaking down the systemic barriers that still shape racial and ethnic status in our profession is going to take significant time, effort, and discussion. Therefore, we can’t stop talking about this important issue the moment something shinier catches our attention. We must continue to have the dialogue in our own clinics—regardless of how uncomfortable it may make you feel—and then take the necessary actions as individuals to create lasting change together.

As the saying goes, “The whole is greater than the sum of its parts.” So, if each of us can put forth the effort to repair some of our own broken parts at an individual and clinical level, we will gradually piece together a more united, more inclusive, and infinitely stronger future for our profession. After all, our patients deserve it.