Like many of you, I am concerned with the current state of the PT industry. Payments continue to decline at a steady rate; new and demanding reporting programs seem to emerge from the woodwork every few years; and even though PTs have the skills to help guide the country through multiple medical crises (e.g., the opioid epidemic, the influx of COVID-19 long-haul patients), we have yet to rise in significant notoriety as a viable medical solution.
That’s not to say that the PT industry is in a bad spot. We’ve recently secured some noteworthy legislative wins after rehab therapists banded together to drive a groundswell of advocacy—and that deserves recognition. But advocacy is a marathon, not a sprint, and while our institutions (e.g., the APTA, APTQI, PPS, WebPT) galvanized many therapists to take action for one particular cause in 2020, that simply won’t cut it moving forward.
We need long-term advocacy buy-in from PTs—but we simply don’t have it right now. How do I know that? Well, WebPT asked thousands of PTs about advocacy for our 2021 State of Rehab Therapy report.
PTs don’t have faith in their institutions.
Advocacy campaigns succeed most often when they inspire collective action—when many people join their voices together and function as a unit. One of the most effective ways to organize these voices is to support an organization that can direct people, like the APTA, APTQI, or the PT-PAC.
And yet, in this year’s industry survey, we found that 50% of surveyed PTs and PTAs were not active members of the APTA. When asked why, 66% of respondents reported that the membership fee is too expensive—and 18% said that they don’t believe the APTA is effective. I have really mixed feelings about this. While APTA dues are nothing to sneeze at (and are higher than their AOTA and ASHA counterparts), I believe the lag in membership has less to do with immediate cost and more to do with perceived ROI. Though the APTA does a lot of great advocacy work and provides a host of great resources to its members, PTs and PTAs simply don’t believe that they get enough bang for their buck.
When it comes to supporting other advocacy organizations, I suspect that cost is less of an issue and awareness is more of one. In the past, I’ve talked about how the Physical Therapy Political Action Committee (PT-PAC) could be the largest healthcare provider PAC in the nation if every PT in America contributed just $20 to the organization. And yet, participation in the PT-PAC continues to lag.
General advocacy participation is not where it should be.
Speaking of participation, the 2021 State of Rehab Therapy report also revealed how many therapists actually participate in industry advocacy. Though last year contained some of the rehab therapy’s most ambitious (and successful) advocacy efforts to date, only 35% of the surveyed therapy professionals knowingly participated in these advocacy efforts. You could spin this one of two ways:
- Rehab therapists were able to enact real change by spurring just a third of the industry into action; and/or
- A large majority of rehab therapists are not participating in critical industry advocacy efforts.
Rehab therapists are clearly a force to be reckoned with when we act as a united front—but there is simply too much apathy toward our industry. To encourage more advocacy buy in, perhaps it’s time to change tactics and refresh our approach to it altogether.
We need proactive—and not reactive—advocacy.
To this point, a majority of our advocacy efforts have been reactionary. We were hit with the PTA and OTA payment differential in 2019; only then did we advocate against assistant payment cuts. We were hit with the 9% payment cut announcement in 2019; we started advocating against it months after its announcement. We were unable to provide virtual care to our patients when the pandemic swept in; only then did we earnestly push for telehealth privileges.
Many will argue that relationships on Capitol Hill revolve around the question “What have you done for me lately?”—and that legislators are only interested in dealing with what sits right in front of them. This may be (somewhat) true, but we need to think about the bigger picture. We need to remember to promote our brand to the big leagues—telling them who we are, what we do, and how we can provide value to patients.
Now is the perfect time—while we have more vested interest than ever before—to rejuvenate our approach to advocacy. Instead of waiting for the next hill to climb, we must build on the momentum we currently have to advocate against the cuts and legislative changes yet to come. We can do this by propping up rehabilitative therapy as a force to be reckoned with in the medical community—a powerful and respected leader that has as much sway as the AMA.
More PTs need to step onto the legislative stage.
One way we can become proactive advocates of physical therapy is to bring our voices directly to the legislative stage. For instance, most other specialties (e.g., orthopedic surgeons, neurologists) have several representatives on key CMS committees and government agencies. (PTs often do not.) Take a look at the 2019 roster of the Medicare Evidence Development & Coverage Advisory Committee—a committee that helps CMS judge what services Medicare should cover. Out of more than its 60 voting members, only one was a PT.
MDs have a loud voice in the conversation about the future of healthcare—and they are hugely influential toward CMS’s decisions. (Case in point: The AMA helped CMS design the budget changes that resulted in the 9% cut to PT Medicare payments.) Therefore, we need more therapists on these committees who can advocate for our interests.
We must build relationships in parallel industries.
If applying for and working on a regulatory advisory committee isn’t your jam, that’s totally okay! There is also a serious need for networking and collaborating with existing committee members. We PTs have a bad habit of siloing ourselves from parallel—and even non-parallel—industries. Think of our fiery competitiveness toward chiropractors and massage therapists. This is simply not the time for that. We must get over our “us-versus-them” mentality and let bygones be bygones when it comes to advocating for national payment and other aligned interests.
I firmly believe in the power of coopetition—when long-standing competitors set aside their differences and bolster each other during difficult times. The idea of working with someone you normally compete with may sound a little wild—that is, until you look at the bigger picture. At the end of the day, we (as in, all healthcare providers) have many of the same goals: to treat patients and ensure that payers give us the compensation we deserve. To this end, I believe that relationship-building has never been more important, because our voices, raised together, can enact meaningful change.
It’s time to explore new avenues for PT advocacy—but to successfully do that, we need to crowd-source input from therapists who work in all corners of the industry. I personally believe that investing in our professional institutions and becoming a vocal presence on the legislative stage is the best way to do that.
So, what do you think? How should we revamp our PT advocacy game? How can we generate more industry interest and participation? If the future of our advocacy efforts doesn’t lie in APTA memberships and PT-PAC contributions, then where is it?
These are questions I encourage all of you to think on—and I ask you to share your ideas below so we can start tackling this problem together. Are you with me?