Come Together Right now

By Terry C. Brown, PT, DPT

Physical therapists work in many different settings and operational structures. During my career, these settings and structures have changed over the years and continue to change today. When I graduated from physical therapy school, therapists expected to work for someone and had abundant choices in location and specialties. The expectation was for a good paying job with ample opportunity to learn from mentors and a patient load that would allow for generous one-to-one patient time. It was also expected that the salary would afford an improved lifestyle and cover the payment of their low-interest student loans. Most of us went to work for hospital systems of one type or another. There weren’t many private practices available and few new grads went directly into them.

Today, there are still hospital systems providing good opportunities for new grads but also a plethora of other options available. Physical therapist entrepreneurs offer a host of opportunities for new grads while advancing practice options far beyond what was available to me. There are so many options in private practice today to consider: cash based, contracting, traditional private practice, large corporate practice, and joint ventures to name a few. These and all other options have the potential to offer a fulfilling career with advancement opportunities.

We, however, have challenges as a profession, and as Private Practice Section (PPS) members. The emphasis on cost containment and required documentation has created an atmosphere that does not support the very reason that most of us went into this field in the first place: “patient care.” It places increased administrative demands on private practices along with diminishing payment that prevents us from offering competitive salaries. It also detracts from the young therapists’ willingness to go into private practice. Student loan debts compared to starting salary make a potential physical therapy student consider other options that have better financial outcomes. In general these two issues, administrative burden and diminished payment, have placed many private practices in an unfair position in the marketplace.

What is to be done? I believe that private practice physical therapy is the greatest value in the medical marketplace today. We must engage payers and providers in mindful discussion of the value proposition we offer. We must have vision of a payment system that is fair and has value to the patient, provider, and payers, and we must lead the way in putting this vision into practice. We have good data available now, and we must continue to mine new data that supports our value.

How do we do it? PPS is engaging with outside resources and with the American Physical Therapists Association (APTA) to drive this discussion. In the past there have been differences of opinion that have created division in our ranks. This has created an environment that has impeded progress toward a better system. It is now time that we all work together to create a vision of what payment will look like five to seven years down the road, a system that will create fair payment, less administrative burden, and improved patient access. No matter the size of our practice, the ownership structure, or the type of patients we see, this will allow us all to prosper and provide quality patient care. It is time to put our differences aside, come to the table under the umbrella of one organization, and truly work together to assure the future of private practice physical therapy.


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