What will be the future of physical therapy? There were alot of clinical therapists that left the field during the COVID years. It also seems we have progressively made it more difficult to become either a PT or PTA.
All the focus is on a nursing shortage
Everywhere we look in the Healthcare News is the continual report of a significant nursing shortage. This is a very real problem especially when you gradually move out from urban centers. The more rural the more intense the problem becomes.
Physical Therapy is having the same problem as nursing
This is also true for Physical therapy. As you start to travel out of urban centers there are less and less therapists available.
Multiple factors impacting the shortage
So what is creating the progressive shortage of therapists? Well there are many factors involved that over years have compounded the problem. Consistently Medicare has been steadily making cuts to reimbursement for therapy services. This creates negative pressure on therapy companies to be able to not only hire but keep good therapists as reimbursement directly effects wages. Without income, how do you pay for benefits and payroll?
There is also the issue of denials for medically appropriate Interventions. For years companies contracted to audit Medicare claims would deny payment for services for simple paperwork errors. In the grand scheme a physical problem was addressed and the patient would have recovery and months afterwards services would be denied for small paperwork errors or “it did not seem complicated enough for the need for a skilled therapist to perform the activity”.
Medicare Advantage Plans
Reimbursement issues can be further compounded by managed care networks utilized by Medicare Advantage plans.
These networks are supposed to follow Medicare guidelines, but don’t necessarily need to. They can also change the rules as they go or add more of a burden of paperwork to increase chances of error and denial of coverage.
The Medicare Advantage plans can also establish their own rates for reimbursement that are independent from Medicare guidelines and fee schedule.
COVID years
During the COVID years there was a significant amount of therapists that decided to retire, or leave the Therapy field all together. They became too frustrated with all the rule changes and increased burden of performing their jobs. This was a very significant cause of caregiver burnout.
So what can we do in the future?
Our profession needs to take back control of our profession. We need to advocate to have our government to establish fair reimbursement policies and hold insurance companies accountable to the same rules. This needs to be done at the grassroots level and be a loud voice every opportunity we have.
As great as it was to further our professional standards by steadily raising the entry level degrees to practice, we have indirectly made it more difficult to adequately establish a workforce.
We need to learn from nursing about establishing a pipeline for future therapists. By looking at nursing there are pathways to advance from CNA all the way to RN. There are realistic programs to allow good nurses to advance along using the skills they have mastered to overall improve the profession and fill the needed positions that require more advanced degrees.
For Physical Therapy there is a very limited and expensive path from Physical Therapist Assistant to Doctor of Physical Therapy. There are only 3 colleges nationwide that have a bridge program. Not only does the lack of locations create a barrier, the shear cost of the transition is immense.
If you ask most PTAs that have years of experience if they would advance their degrees, a large percentage say it is impossible. It is actually easier to disregard any experience that a PTA has and start over in a regular DPT program.
In my opinion this is not a good way to advance our profession and help to facilitate increased participation in our profession. This is very pronounced when looking at more rural settings including rural hospitals and nursing homes.
I hope that our trend reverses itself and we have adequate amounts of Physical Therapists as well as Physical Therapist Assistants to care for our most vulnerable elderly population. I would hate to see what happens if we don’t.
