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.

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