Teaching the Game of Life


How physical therapists can thrive in tomorrow’s market.

By Brett Roberts, PT, DPT

“Your economic security does not lie in your job; it lies in your own power to produce—to think, to learn, to create, to adapt…”1 —Stephen Covey

Our profession is in need of a change in focus. Specifically, the focus of our professional training, which has been too clinically based, much to our unintended detriment. Unless we recreate our profession to include understanding of the economics of health care and best business practices, we run the risk of becoming obsolete in the ever-changing health care market. As patient responsibility for health care decisions increases, our ability to accurately discuss our value in that system will provide us with the economic security that Covey mentions.

This change in educational focus won’t be easy and won’t happen overnight. By actively engaging in educating tomorrow’s future practitioner, we can help create doctors of physical therapy who will thrive in tomorrow’s market. Coming out of the 2014 Graham Sessions in Salt Lake City, I realized for my part that making this change would only occur if I was willing to invest my time to make it happen.

I decided to come up with an innovative solution to tackle this problem using a grassroots approach. I applied this solution most recently at the 2017 Wisconsin Student Conclave. Understanding that Millennials tend to have a metagame mentality, it made sense to come up with a game in which their own input helped to impact the outcome of the game and create conversations around the realities of health care as a business.

Starting with a simple exercise, I had them write down their morning coffee order. After explaining the rules of the game, I asked them to announce their coffee order and randomly assigned a price to their drinks. The prices ranged from a few dollars to an amount well into five figures, regardless of whether they enjoyed the coffee or not. This helps to lead a discussion on the lack of pricing transparency in our health care system. Lack of transparency creates situations in which clinicians are not able to understand, much less discuss, the economic impact of medical treatment. Having this knowledge will empower tomorrow’s therapists to openly discuss the true value we bring to the health care arena.

Next, I had the students determine how many business partners they wanted and team up with people sitting around them. They were asked to come up with a clinic name and defend their choice based on the demographic they hoped to attract to their clinic. Finally, they were asked to decide how many patients a new therapist should see on a daily basis and a fair salary for a new graduate.

From this point, we were able to calculate their hourly wages and utilized their productivity expectations to further set up the simulation. This data was plugged into an Excel spreadsheet that accounted for fixed and variable expenses such as payroll taxes, malpractice insurance, continuing education, health insurance, worker’s compensation insurance, and retirement. This was done to give them a realistic view of the expenses in a typical clinic. The fixed and variable costs were based on a 2.5 full-time equivalent (FTE) clinic, which roughly lined up with the 3-clinician average of the teams.

To simulate the randomness of a typical day, we took a simple dice and attached a unique value to each number. Rolling a “6” resulted in a no show or cancellation. The remaining numbers represented different levels of payment consistent with Medicaid, Medicare, private insurance, cash payment, and worker’s compensation or auto insurance. Using their expected level of productivity, they simulated a typical week in the clinic. Ten visits per day for five days equaled 50 rolls of the dice.

Once the simulations were run, we discussed hidden issues associated with clinic profit or loss. We also discussed the taboo subject of productivity standards and why they may be necessary given the inverse relationship between low-paying visits and high salaries coupled with no risk compensation packages. Finally, we discussed business strategies such as marketing to different demographic groups and how those strategies can lead to higher rates of business success.

I challenge you to continue this grassroots movement. Take this idea and mold it with your business experience to help educate tomorrow’s professional. Use your business acumen as a way to give back, while simultaneously marketing your business to potential hires.

Action Item
Investing your time to help educate tomorrow’s Doctor of Physical Therapy will create a win win situation. First, you’ll help shape future DPT’s understanding of basic business and economic principles. Second, you’ll be able to gain a better understanding of which new grads would best fit the culture of your practice, potentially shortening your recruiting cycle for new staff. So invest a little time, have fun, and help us “Teach the Game of Life.”


1. Covey, Stephen. The 7 Habits of Highly Effective People. Mango Media.

Brett Roberts, PT,DPT, is the president of Roberts & Associates Physical Therapy in Wisconsin Rapids, Wisconsin. He can be reached at Brett@robertstherapy.com.

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