Can We Jump the Fence?


Seize the opportunity to shape better health.

By Mike Riley Jr., PT, DPT

In March 2015, I was having an innocuous conversation with the insurance broker for my company, Professional Therapy Services (PTS). His name is Ashley, and he is a wildly eccentric visionary. He ranted about unnecessary surgeries, imaging, and drug prescriptions, medical errors, and the fact that Americans are about as unhealthy as they have ever been. He then asked if I thought physical therapy could have a role in helping change the culture of one of the companies with which he works.

Of course, we should be able to help, but how would this occur?

Ashley mentioned an onsite health clinic and his vision to change it into a health “system” for people working at this company. With this goal in mind, we went to Chicago for the 13th Annual Congress on Onsite Employee Health Clinics. We listened to wellness and prevention experts talk about the latest and greatest systems, and all the money they saved their companies. Not once did anyone mention utilizing physical therapy. Ashley looked at me and said, “These people are full of it; their programs do not translate to savings for anyone.” He added, “If you guys [physical therapists] can really do this, you are going to have more opportunities than you could ever imagine.”

On January 11, 2016, in Alabama, we signed a contract to provide a physical therapist on site at a manufacturing plant with two thousand workers. PTS collaborated with the clinic operators, health risk management consultants, doctors, counselors, and nursing staff. We brought Jennifer Gamboa’s Sustainable Health Index to the table. Long story short, we sat in a room for 12 hours and amazingly enough, physical therapists drove the discussion, creating new clinical pathways during these sessions.

I have been practicing outpatient physical therapy for 16 years, fighting the same battles that we have all faced. These include decreased payment and utilization and increased government regulation, copays, documentation requirements, and new payment models that have been difficult for staff physical therapists to accept.

Why do I wait for Bill to hurt his back shoveling snow, go to the emergency room, and have an X-ray, get a prescription for pain medication, and then followup with his primary care physician? He is then sent for magnetic resonance imaging (MRI), just so Bill will understand he has a bulging disc.

You see, the problem is not his back. The problem is that he was not ready to shovel the snow in the first place. Being 40 pounds overweight, diabetic, and hypertensive, Bill is in no shape to shovel anything. Bill’s general lack of knowledge on how to manage his chronic diseases is also a problem. Quite frankly, Bill is lucky his back is all he injured and that he did not have a massive heart attack.

As we look to the future, we can truly improve the human experience if we have access to people earlier in their lives. This starts at work. We need to “get on the other side of the fence.” I have only just begun to realize how valuable we may be in helping drive down the cost of health care in this country. If I have just begun to realize how valuable our services are, what do the therapists I work with on a daily basis think about the value we provide as a profession?

When I talk to physical therapists, most do not know the power of their value. They see value in terms of units produced and patients seen. Realizing where our highest point of contribution may be as a profession creates an opportunity for major change.

Currently, physical therapists are only touching a fraction of the population who could benefit from our services. Prevalence of chronic disease is linked to age. In 18- to 44-year-olds, 6 percent reported two or more chronic conditions. That rate jumped 5 times to 32 percent in the 45- to 64-year-olds.1 We have a responsibility to decrease these numbers.

How do we increase self-awareness and unleash real change in our profession? How do we get to 20/20 vision and clearly see the opportunity to shape health? We need to “jump the fence.”

Given the current health climate, we are not seizing the opportunity to work as the entry point to better health.

People change for two reasons, desperation or inspiration . . . I have been inspired to change the way I think about the future of this profession and the value we possess. Which side of the fence will you stand on?


1. Chevarley, FM. Expenditures by Number of Treated Chronic Condition, Race/Ethnicity, and Age, 2012. Statistical Brief #485. December 2015. Agency for Healthcare Research and Quality, Rockville, MD. Accessed April 2016.


Mike Riley Jr., PT, DPT, has been in the outpatient physical therapy profession for more than 16 years. He recently completed EIM’s Executive Program in Private Practice Management and a doctorate in physical therapy. He can be reached at

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