A New Tool in Physical Therapy? Introducing the PTCS
I’ve been part of countless webinars and podcasts on pain science, and one question always seems to pop up: “Forget the research – what kind of patient makes you think, yep, this one need pain education?” Easy answer: the one who’s hit rock bottom.
Clinically, we often measure this with the Pain Catastrophization Scale (PCS) – possibly the worst-named questionnaire in healthcare! Despite the name, the PCS is actually a powerful tool. It helps us understand how “full” or “empty” a patient sees their cup in relation to their pain experience. When someone’s been through the wringer with conflicting diagnoses, failed treatments, growing fear, etc., – their cup feels half-empty (and maybe even cracked). This mindset dampens the body’s natural pain-fighting abilities, stirs up the emotional brain, and, unsurprisingly, erodes trust in healthcare.
But today, I’m flipping the script. Introducing the Physical Therapy Catastrophization Scale (PTCS).
Why? Because after 27 years on the road teaching workshops, seminars, and conferences, I’ve had a front-row seat to the PT profession – chatting with new grads, seasoned pros, clinic owners, educators, and students. And let’s be honest – some days the profession looks like a cup overflowing with possibility. Other days? That cup’s cracked, leaking, and someone’s using it to water down the Kool-Aid. Just like with our patients, the way we see things – our narrative – shapes our energy, decisions, and direction. So, here’s my question to you: How are you seeing the PT profession these days? Cup half full? Half empty? Or are you eyeing a refill?
Is the PT Cup Half Full… or Are We Just Thirsty for Change? Let’s be real. The physical therapy profession is at a crossroads. Some days, it feels like we’re crushing it – expanding our scope, reaching more patients, embracing tech, and finally getting some well-earned recognition. Other days? Well, it feels like we’re duct-taping our careers together with SOAP notes and caffeine (before work, during lunch hours, evenings, weekends and many at my CE classes!).
Here’s a quick reality check:
| The Struggles Are Real | There’s Good News Too |
| Student Debt: Many PTs graduate with $70K+ in loans. ROI? Let’s just say your bank account isn’t impressed.
Declining Reimbursement: Medicare cuts and shrinking insurance payments threaten clinic survival. Burnout: High documentation demands + productivity pressures = therapists eyeing the nearest exit. Workforce Shortages: APTA predicts a PT shortage through 2037. High Competition: In some regions, PT grads are lining up for fewer jobs. Gender Pay Gap: Women, who make up most of the field, still earn less. Limited Mobility: Want to grow? Often means leaving the clinic or starting a business you weren’t trained for. Geographic Disparities: Your zip code might determine your paycheck more than your skill set. Admin Overload: Documentation requirements are stealing your patient time – and your soul. Low ROI vs. Other Degrees: We go to school forever yet earn less than some with shorter degrees. Stigma Around Non-Clinical Paths:Leave the clinic? Cue the side-eyes. Practice Ownership Hurdles: Opening your own shop requires more than just clinical excellence – it’s marketing, tech, finance, and hustle. Medicare Cuts (Again): Reimbursement dropped 9% from 2020–2024. Lack of Diversity: Rising tuition limits access to underserved communities. |
Strong Job Growth: Projected 14% growth through 2033.
Aging Population: Seniors need us more than ever. Chronic Conditions: More pain, more diabetes, more need for PT. Preventive Care Is In: PT is moving beyond rehab into wellness. Telehealth Is Expanding: Access is improving, especially for rural and mobility-challenged patients. Wearables & Tech: Smart devices make tracking progress easier and cooler. AI & Robotics: We’re not obsolete – just enhanced. Specialization: Pelvic health, vestibular, sports – the niches are booming. Direct Access: No referral? No problem. Public Awareness: PT is finally being recognized as a legit alternative to meds and surgery. Entrepreneurship: Cash-based and hybrid models are creating autonomy and upside. Gamification & VR: Healing meets Mario Kart. Regenerative Medicine: Stem cells and PT – yes, please. Holistic Health Focus: PTs are now talking sleep, nutrition, and mental health like it’s 2025 (because, well, it is).
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The Slippery Slope of Pessimism
Now, here’s where things get tricky – and a bit psychological. Dr. Allison Ledgerwood (UC Davis) did a fascinating study showing how people cling to negative framing more than positive. In short:
- Tell someone a surgery has a 70% success rate? They’re all in.
- Tell them the same surgery has a 30% failure rate? Suddenly, it’s a no-go.
And here’s the kicker: once someone sees the negative side, it’s really hard to bring them back to the positive. Sound familiar? This is why it’s hard to shift patients with persistent pain. And… it might also be why you feel stuck right now in your view of the profession.
I call this the PT Catastrophization Scale (PTCS). It’s not a real tool (yet), but I’ve been tempted to start handing it out at conferences.
Because after 27 years teaching and traveling the country, I’m hearing more “cup half empty” comments than “cup half full.” And honestly? Some days I feel it too. I’m proud of my profession. I’ve pushed, advocated, taught, and probably annoyed a few people along the way. But I also get it – it’s hard to stay optimistic when it feels like your profession is running uphill… in sand… with EMRs duct-taped to your back.
So What Do We Do?
- Don’t Disengage: Burnout says “run.” Research says “re-engage.” Connection – real engagement – can refuel your tank. PT is more than a job. It’s a mission.
- Focus on the Patient… and Yourself: Helping people feels good – really good. But don’t forget about you. Learn something new. Build your skills. Level up. Let next year’s you be better than today’s (personally and professionally)
- Be the Change: Criticism is easy. Action is harder – and more powerful. If you don’t like where the profession is going, help steer the ship. Advocate for patients , clinicians and the profession.
- Remember Our Future Is Built Today: We’ve made big strides – manipulation rights, direct access, expanding scope, etc. Those didn’t happen by accident. Neither will what comes next. Choose your battles wisely – and fight for progress.
- Know the Real “Enemy”: It’s not your coworker, your boss, or the new grad asking about salaries. It’s a system that overmedicalizes pain, leans on quick fixes, and sidelines prevention. That’s our common cause – and our call to unify. Stop arguing and spending countless hours discussing minutia!
- Stop Giving it Away: PT training is hard (and worth it) and once earned – don’t minimize it. Own it. Be proud of it. Don’t give it away – you may never get it back. Data shows that 70% of the most common chronic medical conditions seen globally are musculoskeletal in nature and there is a HUGE need for skilled examination and delivery of human movement strategies to deal with these issues.
Final Thoughts
Whether you’re feeling hopeful or hanging on by your TheraBand, know this: the PT profession is still worth the effort. So, how’s your cup today? Half full? Half empty? Or are you just ready for a refill?
