What Is Physical Therapy?


Are we a “neck down” or “neck up” profession?

By Jamey Schrier, PT, DPT, OCS

I attended the Graham Sessions this past January where I heard this question: Are we a neck down or neck up profession?

The Graham Sessions are an open forum think tank to discuss the current state of physical therapy and its future. Physical therapists from the private practice industry (both large and small), technology, academia, and research, as well as representatives from the American Physical Therapy Association (APTA), Private Practice Section (PPS), and Health Policy and Administration (HPA) participate.

Various expert panels discuss important topics affecting the industry, as well as hold point/counterpoint discussions between physical therapists where each person defends a side of a topic. Physical therapists are also invited to share what is on their minds in a 10-minute talk similar to a TED talk.

This was my first invitation and I did not know what to expect. However, a smile came to my face when Carl De Rosa, a prominent physical therapist and business leader, posed the question: “What is physical therapy?” I knew this is exactly the type of question we as a profession have to be asking ourselves.

This simple, unassuming question is so profound because it embodies our dilemma as a profession and organization. The physical therapy profession is in the midst of an identity crisis. We are confused as to who we are and our true purpose in this world. What is the future role of the physical therapist?

When someone asks you: “What is physical therapy?” How do you respond? How should we respond collectively? It is a simple enough question, right? However, it was not so simple to answer as evident in the heated discussions during the Graham Sessions.

I heard once, “All success begins with clarity.” If we have an identity crisis as a profession and are not clear as to who we are, then it becomes impossible to answer Mr. De Rosa’s question.

What is a neck down profession?
A neck down profession looks at physical therapists as mostly “doers.” In other words, we as physical therapists are the chief cooks and bottle washers doing all of the activities required to provide quality treatment and care. A noble intention, but in my opinion, the wrong one. Physical therapists have much more to offer than just being the “doers.”

As physical therapy private practice owners, we take this mindset to a whole new level by including the “doing of activities” to practically every administrative job in the practice and putting them on our plate. This mindset is killing us. This mindset that we were taught in school and communicated by our national organization is spilling over to many of us who are running our practices.

We are taught: “Do it yourself because you are an expert and autonomous.” What about collaboration? What about delegation? Are we not just pigeon holing ourselves deeper and deeper?

The challenge we face is that insurance providers are searching for ways to reduce health care costs. One of those “cuts” will no doubt be to get rid of the overpriced physical therapy “doers” and replace them with less costly people who can deliver similar results.

Are you surprised? Wouldn’t you do the same thing to reduce costs? Is not our true value much more than professionals who help people by doing things to them? Are we not more brains than brawn? Is not the advice, recommendation, and solution that we provide to people actually more valuable than the delivery of physical treatment?

This confusion is our professional problem!
We govern ourselves as neck down doers by placing rules against extenders (physical therapy aides, athletic trainers, etc.) because we are trying to protect the very thing that commoditizes our profession: doing. If not changed, this antiquated mentality will destroy us.

When there is no unifying message within the physical therapy community, including private practice, APTA, academia, and research, it is impossible to have a unifying message to the public.

The result is everyone clamoring to hold on to what they have always done and protect their “turf” at all costs. That includes going after the government or anyone else trying to reduce our payments and limit our “doing.” Stop protecting what we do not need—that creates more rules to protect our “doing” ability!

Instead, we need to focus our efforts on creating a neck up profession! A neck up profession brings incredible value to the market place with their brains. Very similar to how family doctors gather information, assimilate it, and deliver a valuable result to the patient in the form of a solution.

Physical therapists provide solutions to the public every day. That is our value. That is our worth! Yes, we may provide a treatment technique, if needed, but our true worth is the expertise, advice, and direction in determining the patient needs and the best methods to help them!

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In exchange for solutions and value, we are compensated with money. Of course, this is a significant mindset shift from the past and current models. This can be a scary reality to many of us who are stuck in the past and in the “old” way of thinking and doing.

Of course, the current payment model is not set up for this yet! However, it is coming. In the meantime, we have to come together and get organized in our thinking and agreement of who we are: neck up or neck down?

Confusion is the enemy!
Not Obamacare, not the hospital systems, not chiropractors, massage therapists, or acupuncturists. It is us. The more energy we expend on discussing, fighting, and worrying about these things, the less time we spend on creating a whole new playing field.

Let us stop reacting to problems and start innovating and creating. This is what a neck up profession does.

Let us stop complaining to each other and start serving those who appreciate the value we create as physical therapists!

Let us stop killing our profession with outdated laws that limit growth and opportunity for the physical therapy owner. Instead, it is time to start aligning ourselves as an industry with the future of physical therapy!

I believe we are a neck up profession! I believe we offer our valued customers significantly more than just exercises, electric stimulation, or even manual therapy. We offer direction, expertise, and solutions. We offer the ability to synthesize massive amounts of information quickly into easy to understand solutions for our customers.

I believe this is extremely valuable to people who value their time and money.

For us to thrive in the future, not just survive, we have to start seeing ourselves as a neck up profession. A profession that uses our brains more than our brawn.

As I mentioned before, all success starts with clarity.

Without a clear understanding of who we are as a profession, we will never be able to preach a clear message to the public thus creating our identity.

It starts by asking the question: Are we a neck up or neck down profession? Then working together to send a unified message to the public, the lawmakers, and insurance providers to begin to help our profession move forward. 

Jamey Schrier, PT, DPT, OCS, is a business coach to many entrepreneurial-minded physical therapy clinic owners. He can be reached at jameys@schrierpt.com.

Thoughts on the Graham Sessions

Students give their perspectives on the Graham Sessions.


I first heard about the Graham Sessions two years ago at Federal Advocacy Forum. After the concept was explained and some big ideas from the previous years were discussed, I was instantly intrigued. It seemed like a mythical, arcane place that I would never be able to experience, but somehow this year I found myself honored to be sitting in the front row surrounded by some of the most passionate luminaries our profession has to offer. The honest and insightful conversations exceeded expectations and inspired action.

I was in awe of how welcoming and encouraging all of the professionals were to the students in attendance. The thread that connected all of these progressive leaders was the desire to improve the future of our profession. These current leaders understand that they are borrowing the profession from the next generation of the physical therapy family and— with that mindset—guide and mentor students. I am fortunate to have experienced the pure “awesomeness” of the 2015 Graham Sessions and have been inspired to continue to foster candidness and engagement from the future of our profession.

—Robert Hofschulte, SPT


At the 8th Annual Graham Sessions, I sat in a room with arguably some of the most passionate people in our profession. I would be a lying if I did not admit I was a little intimidated to be conversing among names such as Dianne Jewell, Alan Jette, Tony Delitto, John Childs, Paul Rockar, and dozens of other physical therapist with countless years of professional experience. It was after reflecting on my insecurity that I knew I had to push the boundaries of comfort and take a risk. I had to step up to the microphone and let everyone there know what I had to say.

I believe that our future students need to realize that this profession does not need mediocrity. It needs leaders who are willing to lay all their cards on the table daily for the betterment of our profession and the greater good of our patients. In school we are equipped with the tools to treat safely. It is important however to realize that when it comes to taking care of business and working toward innovation, safe is an ugly word. I believe that students today should reflect, learn, and become more comfortable with smart risk taking. When it comes to change, innovation, and preparing for an ever-adapting future, those who are ok with playing it safe will be left in the dust.

—Thomas Janicky, SPT


Many great ideas seem to be followed by two words, “You’re crazy!” I hear echoes of that phrase from family and friends when they ask me about my professional goals and my vision for physical therapy. However, this weekend, I received a different response. At the Graham Sessions, I was surrounded by a population of the most passionate visionaries in our profession. They were delighted to share their wisdom, insight, and experiences. More importantly, these innovative thinkers were genuinely interested in hearing what my vision was for our profession and offered ways they could help me obtain my goals. Me. A student.

I believe that as students, our opinions have more value than we realize. It is easy to compare ourselves to others. We may not be as experienced or as accomplished as those leading the profession now, but they are interested in our vision. I believe we can offer a fresh perspective that is beyond the status quo and will entice others to think about problems and solutions differently. Similarly, leaders can offer their perspective to transform our ideas into obtainable goals. I believe this is necessary dialog that leads to innovation. And as students, we can be instruments and builders of disruPTive innovation. All we have to do is say it aloud.

—Stephanie Weyrauch, SPT


Attending the 8th Annual Graham Sessions was one of the most empowering experiences I have had as a doctor of physical therapy (DPT) student. I was surrounded by the most positively disruptive people in the profession—the ones who will not take no for an answer, who never use the words “it’s always been done this way,” and who strive for a better future for our profession. It was Mike Horsfield who said that the profession of physical therapy is like a farm—we do not own it, we are simply borrowing it from our children. The main goal of the physical therapists sitting in that room is to make our profession better for the generations of physical therapists to come.

As a soon-to-be DPT, I feel compelled to spread this message to the newest generation of physical therapists as well as to current students. With early involvement and an attitude of wanting to change the status quo, we can continue to transform the profession just as those who have come before us have done. We are the future leaders of this profession, and it is up to us to decide now just how green the pastures will be.

—Lauren Kealy, SPT

Turning the Titanic


How to stay afloat in today’s health care industry.

By Michael Eisenhart, PT

Most people know the grim story of the Titanic. Whether or not you prefer the love story version with Leonardo DiCaprio may say a lot about your choice of movies but does not change the end result—a slow horrific demise of a “modern” marvel.

Perhaps it is not a leap to liken the U.S. health care industry to the infamous ship. Both were massive: The Titanic was 833 feet long, weighing 50,000 tons, and the health care industry costs almost three trillion dollars per year, representing more than 17 percent of the Gross Domestic Product. Both were technologically advanced. The Titanic had communications equipment and a massive control panel. And today’s health care has magnetic resonance imaging for seemingly every ache or injury, is spending billions of dollars developing devices that prolong life, and offers drugs that promise to tune chemistry to the unique needs of our genetics. However, both have proven to be slow moving and hard to turn, even when an iceberg lies ahead.

The Band Dispenser


To give or not to give.

By Adele Levine, PT

Before I started working for myself, I sent each of my patients home with a shopping bag loaded with resistance bands—each one a generous length and one in every color. This gift giving was one of the favorite things about my job. I loved new bands’ vanilla scent and soft powdery texture. Standing in the back of the clinic, where the rolls of resistance bands hung, I would sniff appreciatively before yanking off a generous portion—eyeballing it for length as it began to puddle onto the floor by my feet. I would do the same thing with every single color and then I would scoop up the pile and deliver the armload to my patient—who surely felt anxious about what all those resistance bands were going to mean.  

If my old boss saw me standing by the resistance band rack, she would become completely unglued, a reaction I never understood—until I began working for myself and discovered how expensive resistance bands are.

Initially, I decided not to order any because I see patients in their homes. In lieu of equipment, I focus primarily on body-weight strengthening exercises, stretches, and balance drills. But recently a patient requested some resistance exercise band. She was an experienced physical therapy patient and had a resistance band from a previous physical therapist. “It’s getting old,” she said, holding out a red band about seven feet long. Clearly her old physical therapist had shared my past tendencies. “Can I get another one from you?” 

“Nope, sorry.” I said briskly.
“No?” She looked at me in disbelief.
“I don’t have any.” 

The concept that I did not have any resistance bands seemed completely out of place to her, and I could see the judgment wheels churning. Was this really a physical therapist she was seeing?  

The next time I came to her house, she brought up the resistance band issue again. She really felt like she needed replacement band—in spite of the fact that none of the home exercises I had given her to do involved using such a band. “Well, when I order some, I’ll make sure to bring you a piece,” I said cheerfully, knowing the likelihood of that happening anytime soon was slim to none. 

Exercise bands quickly became our issue, and she brought it up every time I saw her. Including one business deal in which she suggested her ordering the roll of resistance band, taking a piece for herself, and selling the rest to me. It began to seem that her lower back pain was not bothering her half as much as the fact that I was not going to transform into a exercise band dispenser. Which, luckily for both of us, was how it ended. With her lower back pain resolved, I discharged her. This patient had made great progress, but my failure to dispense color-coded bands limited her satisfaction overall! 

Adele Levine, PT, is the author of Run. Don’t Walk and a practicing physical therapist in Silver Spring, Maryland. She can be reached at adelelevine@gmail.com.

Run, Don’t Walk by Adele Levine, Penguin, April 2014. ISBN 9781583335390 www.adelelevine.com

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