Are You Living in a Dream World?

By Tom DiAngelis, PT, DPT

Recently, I read an article online from the San Diego Tribune1 about Marine Corps General James Mattis. The general will be retiring soon and, over the years, has been quoted several times. The end of the article listed some of his comments, and one in particular caught my attention: “You cannot allow any of your people to avoid the brutal facts. If they start living in a dream world, it’s going to be bad.”

I realize that the general’s comments are in reference to war, troops, and our enemies, but his comments made me think about our own profession and the constant battles that we face. Between declining payment for services, increasing regulations, and the ongoing problem of physician self-referral, I wonder if many in private practice ignore these facts and live in a dream world—that most likely cannot not be maintained. Are many of our peers in denial and avoiding the brutal facts as the general points out?

I admire the practice owners who realize that they cannot sit back and think that they will survive with the status quo, but instead have the vision and skills to develop innovative practice models, as well as relationships that will position them for the next wave of change. I have spoken with private practitioners partnering with accountable care organizations. I also have spoken to some working with the payer community on shared risk plans to show the value of physical therapist care, and, of course, more practices are turning to cash-based programs and relying less on the third party payer. These are just a few examples, but the point is that these practitioners are not living in a dream world—instead they are facing reality head on and always striving to be out in front.

This is what we all need to be doing because—as the general says—if we do not, it is going to be bad. We have to face up to the facts, not avoid them, and work toward moving private practice physical therapy to the next level. I realize that for many of us this means that private practice, our practices, will look and feel much different. It may be hard for some of us to face the reality that what our practices look like today may not be what they look like tomorrow.

As we continue to experience rapid changes in the health care environment, it is logical that there will be winners and losers. Some practices will flourish, and others will cease to operate. This might be a normal lifecycle, but it is hard to acknowledge with private practice being so young. The Private Practice Section is working to help our members move toward the future and toward the next level in hopes that every practice finds its way. Our Business Models Task Force has completed its work, and we will soon be forming a Business Models Committee to work on these very issues and provide the resources that we need to keep us from getting stuck in a dream world.


1. Kovach C. Gretel. San Diego Tribune. Website Posted January 19, 2013. Accessed February 16, 2014.

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