Dr. Vince Gutierrez, PT, cert. MDT1 Comment on PT profession reflections

PT profession reflections

Long post about the PT profession.

From a WebPT survey:

More than 1 in 10 PT/PTA are considering leaving healthcare altogether.

14% are considering transitions to a non-clinical role within healthcare.

So…about 27% of clinicians are looking to stop being a clinician and 36% are not looking to make any changes in their career path.

These numbers to me are scary.

About 1/4 of our profession is dissatisfied with their decision to practice clinically as a professional.

Where are we going wrong?

Better yet…what’s the solution?

  1. Fewer patients per day
    Maybe. It depends on how many patients are being seen to start with. Based on the same survey, POPTs clinics are averaging 14.4 visits per day, but larger hospitals are averaging 15.6/day. Those companies with 50-149 providers are averaging 16.9 patients per day. I personally think that 10 patients per day is doable, but this will leave time for paperwork after seeing patients. I don’t personally have a problem with this, but staying late only should happen in the event of evaluations, progress notes or discharges. Even for these, they could be done in front of the patient, but there may be a loss in therapeutic alliance with the patient if our head is behind the keyboard on the first day. I personally choose to stay at eye level for evals, progress notes and discharges. I may change levels more frequently during daily sessions to type on the computer.
  2. Making more money?
    This is a tough one. Realistically, the healthcare system is set up to treat professionals like “widget makers”. We essentially get paid per widget made. Meaning we get a % of the revenue generated. In order to get more money, we have to generate more revenue. Una few-for-service model, the only way to generate more revenue is two-fold: bill more units per patient and see more patients per day. One, the other, or both could lead to challenging the therapist’s morals and lead to burnout. This system needs to change, and I believe that it will. Unfortunately, there is no guarantee that if it changes it results in more revenue to the professional. Having experienced the other side of fee-for-service, I would say that PTs that partner with ACO’s and are willing to take some risk, have the potential to have a great work/life balance and get paid a fair wage.
  3. Climb the ladder or growth opportunities?
    Not really in this position, at least not without expanding one’s skill set. The issue is that a PT with 40 years experience and a BSPT (a 4-year degree) has equal opportunities for growth than one with a DPT (6-7 years of education). Clinicians graduate with a DPT and unless they learn how to think outside of the box, develop a niche, become an expert or celebrity, they will always be a widget maker.
  4. Personal values no longer reflect that of the company/culture
    I combined these two because they are very similar for me. When these two are combined, this makes up the largest reason why clinicians are leaving their positions. Anecdotally, I agree and see the same circumstances. Clinicians, at least for now, have a choice as to where to work. We are in an environment in which the number of PTs closely matches the number of positions available. The professional can choose to leave a position and feel confident that there is another opportunity to either find greener pastures or realize that there’s not too many difference in company cultures when the end goal is to maximize profit. I believe that this will be changing in the coming years, as reflected in the APTA’s newest workforce analysis. Unfortunately, this means that clinicians will either stay in an environment that misaligns with his/her values, change to a job for less income (supply/demand), take a job that affords them more pay for the insult to their values or leave the profession altogether. This, I believe, is our largest threat to the profession right now. Burnout, paired with fewer jobs, is the largest threat to the professional. There are options to get out of the rat race, but not everyone is cut out to be an owner or leader. This also comes with its own risks and rewards.

Published by Dr. Vince Gutierrez, PT, cert. MDT

After having dedicated 8 years to growing my knowledge regarding the profession of physical therapy, it seems only fitting that I join the social media world in order to spread a little of the knowledge that I have gained over the years. This by no means is meant to act in place of a one-one medical consultation, but only to supplement your baseline knowledge in which to choose a practitioner for your problem. Having completed a Master of Physical Therapy degree, the MDT (Mechanical Diagnosis and Therapy) certification and currently finishing a post-graduate doctorate degree, I have spent the previous 12 years in some sort of post-baccalalaureate study. Hopefully the reader finds the information insightful and uses the information in order to make more informed healthcare decisions. MISSION STATEMENT: My personal mission statement is as follows: As a professional, I will provide a thorough assessment of your clinical presentation and symptoms in order to determine both the provocative and relieving positions and movements. The assessment process and ensuing treatment will be based on current and relevant evidence. Furthermore, I will educate the patients regarding their symptoms and their likelihood of improving with either skilled therapy, an independent exercise program, spontaneous recovery or if the patient should be referred to a separate specialist to possibly provide a more rapid resolution of symptoms. Respecting the patient’s limited resources is important and I will provide an accurate overview of the prognosis within 7 visits, again based on current research. My goal is to empower the patient in order to take charge of both the symptomatic resolution and return to full function with as little dependence on the therapist as possible. Personally, I strive to be an example for family and friends. My goal is to demonstrate that success is not a byproduct of situations, but a series of choices and actions. I will mentor those, in any way possible, that are having difficulty with the choices and actions for success. I will continue to honor my family’s “blue-collar” roots by working to excel at my chosen career and life situations. I choose to be a leader of example, and not words, all the while reducing negativity in my life. I began working towards the professional aspect of the mission statement while still in physical therapy school. By choosing an internship that emphasized patient care and empowering the patient, instead of the internship that was either closest to home or where I knew that I would have the easiest road to graduation, I took the first step towards learning how to utilize the evidence to teach patients how to reduce their symptoms. I continued this process by completing Mechanical Diagnosis and Therapy courses A-D and passing the credentialing exam. I will continue to pursue my clinical education through CEU’s on MDT and my goal is to obtain the status of Diplomat of MDT. Returning back to school for the t-DPT was a major decision for me, as resources (i.e. time and money) are limited. My choice was between saving money for the Dip MDT course (about 15,000 dollars) and continuing on with the Fellowship of American Academy of Orthopedic Manual Physical Therapists (FAAOMPT) (about 5,000 dollars), as these courses are paired through the MDT curriculum or returning to school to work towards a Doctorate of Physical Therapy degree. I initially planned on saving for the Dip MDT and FAAOMPT, but life changes forced me to re-evaluate my situation. The decision then changed to return for the tDPT, as my employer paid for a portion of the DPT program. My goal for applying to and finishing the Dip MDT and FAAOMPT is 10 years. This is how long I anticipate that it will take to finish paying student loans and save for both programs, based on the current rate of payment. I don’t know if I will ever accomplish what I set forth in the mission statement, but I do know that it will be a forever struggle to maintain this standard that I set for myself.

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1 thought on “PT profession reflections”

  1. Charles November 13, 2022 — 10:59 pm

    Vince this is very simple. The system became what it was because of chronic lack of intestinal fortitude from the physical therapists. I am in year 22—still seeing one on one. And we are few and far in-between. PTs let this happen. The awesome APTA was more worried about getting you in debt with a doctorate for an entry level position than worried about eliminating overlapping patients and dovetailing. That practice should be made illegal–period. But the real problem is this lack of ethics is the mainstream not the exception. PTs won’t stand up—that’s it and that’s all. PTs keep taking back the lifestyle problem patient that they can’t fix. PTs won’t tell a doctor his order is inappropriate because that person can’t be fixed by PT. And now your new cash cow is keeping them on for “chronic pain management” which is a chronic waste of time and money. You would be surprised what happens when all the PTs state that the management change or they walk out. I’ve seen that one time in those 22 years now. The rest of the time everyone folds. If PTs would bring back integrity to the profession on all levels they would find once more that they might love their careers instead of many looking to leave it. Some of us warned you this would happen decades ago. The unethical clinic used to be the exception and now it is the rule. It became accepted because the PT let it. My letter to Advance in 2004 screamed at the profession to regain its morals. It didn’t and now we have what we have.

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